1.1 The need for a guideline

Cutaneous melanoma, previously referred to as cutaneous malignant melanoma, is a malignant tumour of cutaneous melanocytes. The incidence of melanoma has been increasing rapidly for the last few decades in most parts of the world. The reasons for this are not clear although the role of sunlight exposure is widely accepted.

The epidemiology of cutaneous melanoma in Scotland has been described in detail elsewhere.¹ Currently, over 600 cases of invasive disease are diagnosed in Scotland every year. Between 1979 and 1998, age-standardised incidence rates increased from 3.5 to 10.6 per 100,000 in males, and from 7.0 to 13.1 in females. After 1995, the rate of increase levelled out in females younger than 65 years at diagnosis. Between the years of diagnosis 1979 and 1993, five year survival increased from 58% to 80% in males, and from 74% to 85% in females. Most of this improvement in prognosis was attributable to a higher proportion of thinner tumours.

Although melanoma is the major cause of skin cancer mortality, it is usually curable, if recognised and treated at an early stage. The visibility of the vast majority of melanomas makes them accessible tumours. There is variation in approaches to all stages of melanoma management in Scotland. Surgical management of the primary lesion has changed considerably over time. Melanoma in its later stages remains relatively resistant to currently available treatments. Considerable efforts have been made to encourage increased public and professional awareness of melanoma in recent years.

1.2 Remit of the guideline

Many specialties and professions are involved in the management of patients with melanoma. This guideline provides advice at all stages of the patient’s pathway of care, from primary prevention to early recognition, treatment and follow up. The guideline covers both established management techniques and newer approaches such as sentinel node biopsy. It does not address melanomas of non-cutaneous origin such as melanomas arising from mucosae, ocular melanomas and other rare non-cutaneous sites.

The guideline should be of interest and relevance to primary care providers, dermatologists, surgeons, pathologists, medical and clinical oncologists, public health physicians, nurses, health promotion professionals and epidemiologists.

1.3 Patient and carer information

Effective communication and appropriate information giving are integral components of high quality patient care. The guideline highlights the points throughout the journey of care when patients should routinely be given information about their care and the services available to them.

1.4 Statement of intent

This guideline is not intended to be construed or to serve as a standard of medical care. Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. These parameters of practice should be considered guidelines only. Adherence to them will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement regarding a particular clinical procedure or treatment plan must be made by the doctor, following discussion of the options with the patient, in light of the diagnostic and treatment choices available. It is advised however that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient’s case notes at the time the relevant decision is taken.

1.5 Review and updating

This guideline was issued in 2003 and will be considered for review as new evidence becomes available. Any updates to the guideline will be noted on the SIGN website: www.sign.ac.uk