Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Initial investigation,
diagnosis, staging and
management
Evidence from observational studies does not support widespread,
routine use of CT in the management of patients with melanoma, but
supports consideration of CT on an individual basis.
Surgical therapies
Surgical excision is the standard therapy for the great majority of skin
cancers.
Evidence-based guidelines from the UK recommend that lesions
suspected of being melanoma are initially excised as full-thickness
skin biopsies, including the whole lesion with a 2–5 mm clinical
margin of normal skin laterally and with a cuff of sub-dermal fat.
Histologically confirmed melanoma tumours require referral to a
specialist centre for excision, with a margin of between 1 cm and 3
cm, stratified according to Breslow thickness.
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Evidence from two systematic reviews suggests that in the excision of
melanoma surgical margins of 3–5 cm have no advantage, in terms of
local recurrence, overall survival and disease-free survival, over
margins of 1–2 cm.
One RCT that compared 1 cm versus 3 cm surgical excision margins
for melanoma found an advantage of borderline statistical significance
in terms of locoregional recurrence for 3 cm margins over 1 cm
margins, with no significant difference in survival detected.
Mohs micrographic surgery
There is systematic review evidence to support the use of Mohs
surgery for large, high-risk BCCs located at surgically complex regions
of the face.
Systematic review evidence also exists for the use of Mohs surgery in
patients with recurrent NMSCs, in patients with tumours with
aggressive growth histology and in patients with large NMSCs with
indistinct margins.
Sentinel node biopsy (SNB)
No randomised controlled trials reporting on survival following SNB in
patients with melanoma have been published. There is good evidence
that SNB for melanoma may be useful as a staging investigation, and
participation in EORTC adjuvant trials may become dependent on its
availability.
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National Institute for Health and Clinical Excellence