Melanoma: Assessment and Management

Excerpt

Cutaneous melanoma is increasing in incidence in many of the developed countries as this form of cancer occurs predominantly in pale skinned people who expose themselves to intense sunlight, especially when taking holidays in sunny places. The increased work-load for melanoma services resulting from this increase is furthermore complicated by the fact that the individuals with the most rapid rate of increase in incidence are those over the age of 60 and especially men. Male sex and age are two poor prognostic factors for melanoma and therefore the likelihood is that despite efforts to promote primary and secondary melanoma prevention, melanoma mortality is likely to increase rather than decrease. Although the incidence trends described above are of concern, for the first time in very recent years, the advent of therapies targeted to driver mutations (such as inhibitors of BRAF) and of T cell checkpoint inhibitors which both have efficacy in melanoma is in the process of rapidly changing management of this disease. Use of both classes of drugs has been the subject of NICE technology appraisals in recent years and these have been cross referenced in the text.

As a result of these changes both in incidence and treatment, the development of a NICE Clinical Melanoma Guideline is very opportune. The fact that some of the therapeutic changes are recent however means that important issues such as the approach that can be taken to imaging during follow up, are in a state of evolution and some aspects of the Guideline may need review in the near future.