For patients to be eligible to start adjuvant treatment, they must commence treatment within 12 weeks of their final surgery for the treatment of melanoma. This will usually mean requesting imaging as well as referrals to surgeons and oncologists at the same time to achieve this time frame.
The American Joint Committee on Cancer (AJCC) staging for melanoma is detailed below. It is recommended that the responsible clinician calculates the initial staging at the time of reviewing the pathology report as waiting for MDT discussion might delay the referrals for patients who are clearly good candidates for surgery and adjuvant therapy.
Early discussion at national MDT or regional MDT recommended. Some patients may be better served proceeding straight to immunotherapy but these patients will have to be discussed on a case by case basis in an MDT setting.
Accurate assessment of patient fitness for SLNB +/- immunotherapy - comorbidities (particularly immune-related) which may place the patient at high risk of complications of immunotherapy must be available for MDT discussion.
BRAF should be requested as standard on all potential stage IIB/IIC cases.