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South African Medical Journal

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Guideline on the Management of Melanoma

Melanoma Advisory Board

Abstract


Objective.
1. The Guideline for the Management of Melanoma has been developed in an attempt to improve  management through the process of locating the best available evidence on which to base decisions. It is expected to help to improve the quality of care.
2. Melanoma remains a common cancer in South Africa. Despite the achievement of earlier diagnosis, it would appear from current statistics that at least 850 people continue to die of melanoma each year. Many of these deaths occur at a younger age than for other solid tumours, so the number of years of life lost due to melanoma exceeds that of many other cancers. It is seen as imperative to maximise effective management of melanoma.
3. Prevention of melanoma has not yet been achieved, and there are no conclusive data to show that  current promotion of sun avoidance has substantially altered its incidence.
4. Early detection is an important factor in melanoma management, with diagnosis based mainly on  changes in colour, diameter, elevation and border (irregularity of outline) of a skin lesion, asymmetry of a lesion, or a lesion different from other naevi. People at high risk of melanoma should be offered a surveillance programme.

Recommendations.
1. All clinicians should be trained in the recognition of early melanoma.
2. If there is doubt about a lesion, the patient should be referred for specialist opinion (if readily available) or a biopsy should be undertaken. Biopsy of a pigmented lesion should be done only on the basis of  suspicion of melanoma. Excision with a 2 mm margin is adequate.

3. Prophylactic excision of benign naevi is not recommended. In general, elective lymph node dissection is not indicated.

4. People with high-risk primary melanoma, lymph node involvement and melanoma in unusual sites (e.g. mucosal and disseminated melanoma) should be managed with support from a melanoma centre.
Validation. Melanoma management involves many medical specialties. Guidelines should therefore be developed through a multidisciplinary consensus. The Melanoma Advisory Board consists of a forum of dermatologists, oncologists, plastic surgeons and pathologists.
Guideline sponsor. The meetings of the Melanoma Advisory Board are sponsored by Schering-Plough.




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