Melanoma: assessment and management summary of the 2022 update of the National Institute for Health and Care Excellence guidelines.

Abstract

Melanoma is the fifth most common cancer in the UK, accounting for 4% of all new cases of cancer, with a predicted 7% increase in incidence between 2014 and 2035. In parallel, since the initial publication of the National Institute for Health and Care Excellence (NICE) melanoma guidelines in 2015, there has been a paradigm shift in the management of the disease, with the introduction of effective systemic therapies. These innovations have reshaped the management of melanoma throughout the patient journey, and improved clinical outcomes. Surgical management has evolved, with the role of sentinel node biopsy in staging and management of regional lymph nodes becoming clearly defined, and a reduction in the need and indications for morbid block dissections. In advanced disease, effective therapies have allowed a de-escalation of surgery, changing the role and sequencing of local therapies. Regional therapies for in-transit disease have expanded and are effective in controlling this pattern of disease as part of multidisciplinary care. These advances have undoubtedly improved the care for people with melanoma, but they have also increased the complexity of management. In this context, this article seeks to summarize the most relevant of the recent updates to the NICE guidelines.