Melanoma: Assessment and Management

NICE NG14 July 2015

Imaging

1.5 Staging Investigations.

1.5.3 Offer CT staging to people with stage IIC who have NOT had sentinel lymph node biopsy, and to all people with stage III or stage IV melanoma.

1.5.4 Include the brain as part of imaging for people with suspected stage IV melanoma.

1.5.5 Consider whole‑body MRI for children and young people (from birth to 24 years) with stage III or suspected stage IV melanoma.

1.9 Follow Up after treatment for Melanoma.

1.9.3 Consider including the brain for people having imaging as part of follow‑up after treatment for melanoma.

1.9.4 Consider imaging the brain if metastatic disease outside the central nervous system is suspected.

1.9.5 Consider CT rather than MRI of the brain for adults having imaging as part of the follow-up or if metastatic disease is suspected.

1.9.12 & 1.9.14 Do not routinely offer screening investigations ( including imaging and blood tests ) as part of follow-up to people who have had stage IA, IB-IIB or stage IIC with a negative sentinel lymph node biopsy.

1.9.16 Consider surveillance imaging as part of follow-up imaging for people who have had stage IIC melanoma with no SNLB or stage III melanoma who would be eligible for systemic therapy as a result of early detection of metastatic disease if: - there is a clinical trial of the value of early imaging or - the SSMDM agrees to a local policy and specific funding for imaging 6-monthly for 3 yrs is identified.

1.9.17 Offer personalized follow up to people who have has stage IV melanoma.

So, the important bits are - CT rather than MR for brain. - Stage III or IIc refusniks only. - 6/12 seems to be accepted and only if there is funding.