Melanoma - a management guide for GPs.

BACKGROUND

The incidence of melanoma in Australia continues to rise. Early diagnosis and management before the melanoma has metastasised provides the best opportunity for a favourable outcome.

OBJECTIVE

This article discusses the management of melanoma once a clinical diagnosis has been made.

DISCUSSION

If melanoma is suspected, initial excision biopsy is recommended. Wide excision margins are then based on reported tumour thickness. Sentinel lymph node biopsy provides important prognostic information and a probable survival benefit for patients with intermediate thickness melanomas. Other staging tests are not indicated in patients with clinically localised primary melanomas. Complete lymph node dissection is required if microscopic or macroscopic disease is present in regional nodes. Intransit metastases are best managed at specialist melanoma treatment centres. For patients with widespread systemic metastases, new drug treatments including BRAF inhibitors and anti-CTLA4 antibodies are prolonging survival, but unfortunately most patients ultimately relapse.