NICE publishes new guideline on most deadly form of skin cancer

Melanoma is the third most common skin cancer in the UK and accounts for more cancer deaths than all other skin cancers combined. In 2012, there were over 2000 deaths from melanoma, and over the last thirty years, rates of malignant melanoma in Britain have risen faster than any of the current ten most common cancers. Incidence rates have also increased more than five-fold since the mid 1970s[i].

Melanoma is a type of skin cancer which can spread to other parts of the body. It is most common in people who have pale skin, tend to burn in the sun or have many moles. It occurs when some cells in the skin begin to develop abnormally and is thought to be caused by exposure to ultraviolet (UV) light from natural or artificial sources. However, this risk is more strongly linked to intermittent exposure to high-intensity sunlight rather than to chronic or continuous sunlight exposure.

The new NICE guideline focuses on assessing and managing melanoma, working out how far it has progressed (staging), identifying treatments for each stage of the disease, including when the cancer has spread, and outlines the best follow-up care after treatment.

Recommendations include:

• Improved, preferably nationally standardised information should be made available to all patients with melanoma. Information should be appropriate to the patients’ needs at that point in their diagnosis and treatment, and should be repeated over time. The information given must be specific to the type of lesion, type of treatment, local services and any choice within them, and should cover both physical and psychosocial issues.
• Dermoscopy[ii] and other visualisation techniques: Assess all pigmented skin lesions that are either referred for further assessment or identified during follow-up in secondary or tertiary care, using dermoscopy carried out by healthcare professionals trained in this technique.
• The guideline also makes recommendations about the use of sentinel lymph node biopsy and subsequent lymph node removal where the biopsy shows evidence that the disease has spread.
• Include the brain as part of imaging for people with suspected stage 4 melanoma. Consider whole-body MRI for children and young people (from birth to 24 years) with stage 3 or stage 4 melanoma.
• Follow-up after treatment for melanoma: Perform a full examination of the skin and regional lymph nodes at all follow-up appointments. Consider personalised follow-up for people who are at increased risk of further primary melanomas (for example people with atypical mole syndrome, previous melanoma, or a history of melanoma in first-degree relatives or other relevant familial cancer syndromes). Consider including the brain for people having imaging as part of follow-up after treatment for melanoma.

Commenting on the new guideline, Professor Mark Baker, Centre for Clinical Practice director at NICE, said: “At this time of year, we all want to get out there and enjoy the sun, and there are plenty of ways to do that safely: using a sunscreen with a high SPF, spending time in the shade between 11am – 3pm, ensuring you don’t burn, and covering up with a hat, t-shirt and sunglasses. But, overexposure to ultraviolent light from the sun can have very serious repercussions.

“Melanoma causes more deaths than all other skin cancers combined. Its incidence is rising at a worrying rate – faster than any other cancer. If it is caught early, the melanoma can be removed by surgery. If it is not diagnosed until the advanced stages, it may have spread, so it is harder to treat. However, there are a number of options available to help slow the progress of the disease and improve quality of life.

“This new guideline addresses areas where there is uncertainty or variation in practice, and will help clinicians to provide the very best care for people with suspected or diagnosed melanoma, wherever they live.”

The new guideline is available at: http://www.nice.org.uk/guidance/ng14