Evidence drives sweeping changes to melanoma treatment recommendations

Updated national clinical guidelines recommend not performing major lymph node surgery routinely for low-volume melanoma in lymph nodes, and active drug therapies as standard for advanced melanoma

Melanoma patients across Australia will benefit from today’s release of updated clinical care guidelines that recommend sentinel node biopsy and drug therapy as important tools in the management of melanoma.

Professor John Thompson AO, Chair of the Guidelines Working Group and Senior Faculty Member at Melanoma Institute Australia, said the updated guidelines reflected new and advanced diagnostic and treatment options for melanoma resulting from research reported over the last five years.

"The melanoma treatment landscape has changed dramatically in recent years due to extensive and ongoing research and clinical trials, and it is vital that frontline healthcare professionals across Australia are aware of new diagnostic techniques and treatments that are saving lives," Professor Thompson said.

"Sentinel lymph node biopsy is an important, minimally invasive staging procedure which enables clinicians to determine a patient's risk of recurrence of melanoma. Discussing this procedure with patients is important because if the sentinel node has melanoma in it, drug treatment can reduce the chance of the melanoma returning.

"Recent clinical trial results have shown that complete removal of all remaining lymph nodes, previously the standard treatment recommendation, usually provides no additional patient benefit, and it is no longer standard management," he said.

The new Clinical Guidelines for the Diagnosis and Management of Melanoma have been developed by Cancer Council Australia and Melanoma Institute Australia, with financial support from the Skin Cancer College Australasia and the Australasian College of Dermatologists. The updated guidelines have been released today at the Australasian Skin Cancer Congress on the Gold Coast, and are published online.

Professor Georgina Long, Conjoint Medical Director of Melanoma Institute Australia, said the updated guidelines cover every stage of melanoma.

"These sweeping changes to the melanoma clinical care guidelines are all evidence based and have a huge potential to save lives and benefit patients across the country," Professor Long said.

"New data show that sentinel lymph node biopsy is critical to understanding whether a patient is at sufficiently high risk to benefit from a course of drug therapy to prevent recurrence of melanoma.  This has been standard in breast cancer for many years, and now melanoma patients have a similar management algorithm.

"In addition to detailing potentially life-saving drug therapy options, the updated guidelines also highlight areas in which more research is needed, and put an emphasis on frontline healthcare providers referring patients to clinical trials when established treatments aren't available," she said.

Other key recommendations covered in the updated guidelines include:

• How to identify individuals at very high risk of melanoma, and what education they and their partners should receive to help them detect skin cancer early.
• The importance of doctors investigating any lesions that grow or change in size, shape, colour or elevation over a period of more than a month.
• New guidelines for biopsies and excisions.
• The need for melanoma survivors to be aware of their risk of developing further primary melanomas and for health professionals to remind those with a prior diagnosis to use sun protection.

Australia has one of the highest rates of melanoma in the world, with one Australian dying from melanoma every five hours. More than 14,000 Australians are expected to be diagnosed with melanoma this year.

"There is no doubt that early detection followed by prompt and appropriate treatment are still key to surviving melanoma, and it is hoped that these updated guidelines will improve the diagnosis and effective treatment of early stage melanoma as well as the treatment of later stage melanoma," Professor Thompson added.

"The message to Australians is simple - keep a close eye on your skin and if anything looks suspicious or changes, get it checked by a medical professional who now has access to up-to-date, evidence-based treatment guidelines," he said.

The guidelines are available for download by healthcare professionals at wiki.cancer.org.au/australia/Guidelines:Melanoma