Clinical Practice Guidelines in Australia and New Zealand for the Management of Melanoma: Evidence-based best practice guidelines

Contents......Page 5
Foreword......Page 11
New Zealand foreword......Page 12
Preface......Page 13
Executive summary......Page 15
Introduction......Page 17
Summary of clinical practice recommendations......Page 23
1 	Prevention......Page 41
2.1	Proportion of population undergoing whole-body skin examination......Page 45
2.2	Accuracy of whole-body skin examination by health professionals......Page 46
2.3	Thickness of melanoma detected through skin screening by health professionals......Page 47
2.4	Cost-effectiveness of population-based skin screening by health professionals......Page 48
2.5	Effectiveness of whole-body skin examination by health professionals in reducing melanoma mortality......Page 49
3.2	Baseline risks due to age and sex......Page 55
3.6	Sun exposure and its surrogates......Page 56
3.7	Family history of melanoma......Page 57
3.9	Good practice point......Page 58
3.10	Genetic risk factors and testing......Page 59
4 	Classification and staging of melanoma......Page 63
Table 3: Melanoma TNM classification......Page 64
5.2	How doctors detect melanoma......Page 67
5.3	Clinical melanoma subtypes......Page 68
5.6	Evidence-based assessment of aids to the clinical diagnosis of melanoma......Page 69
5.7	Total body photography (TBP) for early melanoma diagnosis in high-risk subjects......Page 70
6.2	Partial biopsies......Page 75
6.3	Alternative approaches......Page 77
6.4	Good practice point......Page 78
7 	Histopathological reporting of cutaneous melanoma......Page 81
7.1	Comments on the histopathological reporting of melanoma......Page 82
Table 5: The histological features of persistent primary melanoma versus......Page 84
7.3	Recommended terminology and synonyms for cutaneous melanoma......Page 86
7.4	Format of the report......Page 87
7.5	Pathology report on sentinel and non-sentinel lymph nodes......Page 90
7.6 Pathology report on lymph node dissection specimens......Page 91
8.1	Investigations following the diagnosis of primary melanoma......Page 95
8.2	Investigations following the diagnosis of locoregional disease......Page 97
8.3	Investigations following the diagnosis of metastatic melanoma......Page 99
9.1	Risk of melanoma in patients with congenital melanocytic naevi......Page 103
9.2	Approach to management of patients with congenital melanocytic naevi......Page 104
9.3	Good practice points......Page 106
10 	Lentigo maligna......Page 109
11.1	Review of the evidence......Page 113
11.2	Good practice points......Page 115
12.1	Sentinel lymph node biopsy......Page 119
12.2	Therapeutic lymph node dissection......Page 122
12.3	Good practice points......Page 124
13.1	Persistent melanoma......Page 127
13.2	Local metastasis, in transit metastasis and satellitosis......Page 128
13.3	Regional lymph nodes......Page 130
14 	Adjuvant systemic therapy of melanoma......Page 133
15 	Treatment of disseminated melanoma......Page 135
15.2	Surgery......Page 136
16.1	Effect of psychosocial interventions in patients with melanoma......Page 141
16.2	Communication strategies to reduce psychosocial morbidity and 	unmet needs in patients with melanoma......Page 145
16.3	Influence of patients’ psychosocial characteristics on prognosis......Page 146
16.4	Influence of psychosocial interventions on prognosis......Page 148
17 	Palliative care in melanoma......Page 153
17.1	Timing of referral for palliative care......Page 154
17.2	Patients and families who benefit from referral to specialist palliative care......Page 155
18.1	Review of the evidence......Page 159
19.2	Undertaking follow-up......Page 161
19.3	Follow-up intervals and tests......Page 162
19.4	Value of follow-up......Page 163
20 	Clinical trials......Page 167
20.1	Good practice point......Page 168
21 	Treatment of desmoplastic melanoma......Page 169
22.1	Melanoma of the anorectal region......Page 171
Table 6: Studies comparing Abdomino-pelvic resection and sphincter preserving wide local excision for patients with localised anal melanoma (more than 30 patients and published since 1990)......Page 174
22.4 Melanoma of the male genito-urinary tract......Page 175
22.5	Vulval melanoma......Page 176
22.6	Vaginal melanoma......Page 177
22.7	Good practice points......Page 178
23 	Occult melanoma......Page 181
24 	Ocular melanoma......Page 183
25.1	Diagnosis......Page 185
25.2	Treatment and survival......Page 186
26.2	Melanoma and pregnancy......Page 191
26.4	Treatment of melanoma during pregnancy......Page 192
26.5	Melanoma and hormone replacement therapy and the oral contraceptive pill......Page 193
27.1	Prognostic Factors......Page 197
Table 8: Survival rates for melanoma TNM and staging categories......Page 198
28 	Complementary and alternative medicine......Page 203
28.1	CAM—what patients find worthwhile......Page 204
28.2	Comparing CAM and conventional therapies for melanoma......Page 205
28.3	Value for money and CAM therapies......Page 206
29.1	Melanoma in non-Caucasians......Page 209
29.2	Good practice point......Page 211
30.1 Melanoma in Maori......Page 213
30.2	Good practice points......Page 214
30.3	Melanoma in Pacific peoples in New Zealand......Page 215
30.4	Good practice points......Page 216
Appendices......Page 219
Table A1: Claims – National Medical Defence Organisation (1990–2005)......Page 220
Appendix 2:	Guideline development process......Page 222
Appendix 3: Working party membership and contributors to guidelines and public consultation submissions received......Page 230
Appendix 4: Dermoscopy versus naked eye examination for the diagnosis of melanoma......Page 236
Appendix 5: Recommended terminology and synonyms for cutaneous melanoma......Page 243
Appendix 6: New Zealand palliative care definition......Page 244
Abbreviations and glossary......Page 249
Index......Page 257
Table 1: Trends in five-year relative survival from melanoma diagnosed in New South Wales, Australia, from 1980 to 1998......Page 20
Table 2: Designations of levels of evidence according to type of research question......Page 24
Table 4: Stage groupings for cutaneous melanoma......Page 66
Table A2: Designations of levels of evidence according to type of research question......Page 226
Figure 2: Trends in the age-standardised mortality rates (ASR) of melanoma in Australia and New Zealand......Page 18
Figure 3: Distribution of lymph node metastases for melanomas 1.2–3.5mm thick......Page 120