New NICE melanoma guideline: vitamin D and SLN biopsy included

August 6, 2015

Melanoma: assessment and management guideline

In July 2015 NICE (National Institute for Health and Care Excellence) in the UK published its new guidance for the assessment and management of melanoma in children, young people and adults. The guideline, which covers the full pathway of care, includes recommendations on managing low vitamin D levels and the use of sentinel lymph node biopsy for staging. It aims to reduce variation in practice and improve survival.

The guideline has been developed for:

• Healthcare professionals working in primary, secondary and tertiary care
• People with melanoma and their families and carers.

The guideline recommendations address:

• Assessing and staging melanoma
• Treating stages 0–II melanoma
• Treating stage III melanoma
• Treating stage IV melanoma
• Follow-up after treatment
• Managing suboptimal vitamin D levels

Managing suboptimal vitamin D levels

As outlined in an associated media release, the guideline recommends that all people with melanoma should have their vitamin D levels measured at diagnosis in secondary care. Measuring vitamin D levels at diagnosis allows doctors to identify people with melanoma whose vitamin D levels are low and who might benefit from supplements in line with national policies. It will also help identify people with high vitamin D levels who do not need supplementation and in whom supplementation might be harmful.

Use of sentinel lymph node biopsy for staging rather than treatment

The guideline recommends the use of sentinel lymph node biopsy as a staging rather than a therapeutic procedure for people with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm. Patients should also be given detailed verbal and written information about the possible advantages of using the procedure using a table provided.

According to NICE, clinicians should explain that there are no clear survival benefits to using the procedure. However, it can be used to predict what might happen in the future and people who have had the operation may be able to take part in clinical trials of new treatments for melanoma.

Sources:
http://www.nice.org.uk/guidance/ng14
http://www.nice.org.uk/news/article/first-guideline-on-deadliest-form-of-skin-cancer-to-reduce-variation-in-carehttp://www.huffingtonpost.co.uk/2015/07/29/new-mel...