Revised U.K. guidelines for the management of cutaneous melanoma 2010

Abstract

NHS Evidence has accredited the process used by the British Association of Dermatologists to produce guidelines. Accreditation is valid for three years from May 2010 and is applicable to guidance produced using the processes described in the British Association of Dermatologists' guidelines development manual (Bell & Ormerod, 2009). More information on accreditation can be viewed at http://www.evidence.nhs.uk.Disclaimer These guidelines reflect the best published data available at the time the report was prepared. Caution should be exercised in interpreting the data; the results of future studies may require alteration of the conclusions or recommendations in this report. It may be necessary or even desirable to depart from the guidelines in the interests of specific patients and special circumstances. Just as adherence to the guidelines may not constitute defence against a claim of negligence, so deviation from them should not necessarily be deemed negligent. These guidelines are published simultaneously in the British Journal of Dermatology (DOI 10.1111/j.1365‐2133.2010.09883.x) and the Journal of Plastic, Reconstructive & Aesthetic Surgery (DOI 10.1016/j.bjps.2010.07.006). These guidelines for the management of cutaneous melanoma present evidence‐based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiology, diagnosis, investigation and follow up. Contribution to these guidelines has been made by a large number of clinicians. They have also been endorsed by, or have had input from, representatives of the following groups or organizations: the U.K. Melanoma Study Group, the British Association of Dermatologists, the British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Royal College of Physicians, London, the Association of Cancer Physicians, the Royal College of Radiologists, London, the Royal College of Surgeons of England, the Royal College of Pathologists (pathology section only), the Royal College of General Practitioners, London, and the Department of Health. These consensus guidelines have been drawn up by a multidisciplinary working party with membership drawn from a variety of groups and coordinated by the U.K. Melanoma Study Group and the British Association of Dermatologists. The guidelines deal with aspects of the management of melanoma from its prevention, through the stages of diagnosis and initial treatment to palliation of advanced disease. PubMed literature searches for this guidelines revision were carried out to identify publications from 2000 to April 2010, with search terms including: melanoma genetics, epidemiology, early diagnosis, risk factors, clinical features, pathology, surgery, chemotherapy and clinical trials. Relevant materials were also isolated from reviews and other publications identified from the PubMed searches, independent searches carried out by the authors, as well as materials collected by the authors as part of their ongoing professional interest in the latest developments in this clinical area. Levels of evidence to support the guidelines are quoted according to the criteria stated in Appendix 1. The consultation process for British Association of Dermatologists guidelines and their compliance with guideline recommendations have been published elsewhere.1, 2 There are arguments in favour of newer guideline grading methods, such as those of GRADE,3 but the authors believe that the system used here allows greater potential for consensus in areas of conflicting evidence or where evidence sources are not directly comparable. In some instances, this is not due to an absence of high quality (Level Ib) trials but because different entry criteria or endpoints preclude direct comparison of results; in other cases interpretation of the clinical significance of results has been challenged. To assist production of unified guidelines taking account of these issues, the ‘quality of evidence’ grading used in these guidelines differs slightly from that used in other British Association of Dermatologists current guidelines; the ‘strength of recommendations’ grading is the same as used in many other publications. Where no level is quoted the evidence is to be regarded as representing Level IV (i.e. a consensus statement). The intention of the working party was to agree best practice for the management of melanoma in the belief that this will promote good standards of care across the whole country. However, they are guidelines only. Care should be individualized wherever appropriate. These guidelines will be revised as necessary to reflect changes in practice in light of new evidence. 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