Adjuvant stage melanoma IIB/IIC referral and assessment guidance

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Warning

This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of this guidance, taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.


The following pathways have been agreed as the preferred treatment pathway for the majority of patients. These are an indicative guide of current treatment practice as agreed by clinicians across Scotland.

These pathways are not comprehensive treatment protocols, clinicians should refer to local or regional SACT protocols for full details on inclusion criteria, dosing and administration recommendations. Links are included to regional or local protocol databases where available.

Where SMC or NCMAG advice is in place and remains current, a link has been provided to the relevant advice.

Whilst some standard alternative treatments have been incorporated where appropriate, the pathways do not take all individual patient factors into account and may not be appropriate for all patients.

Occasionally, where there is an existing gap or unmet need in a particular patient group, the pathway may highlight or identify a potential alternative treatment option that is not routinely available for use. This acknowledgement is not a recommendation, nor does it override local or regional processes for individual treatment requests.

Clinicians should continue to discuss and agree with patients the most appropriate treatment choice for them. All SACT and supportive therapy should be prescribed in line with local and regional governance processes. 

 

Key points

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.

AJCC Staging

Clinical Stage Groups (extracted from the eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system implications for melanoma treatment and care).

Clinical Stage/Group T N M
0 Tis N0 M0
IA T1a N0 M0

IB

 

T1b

T2a

N0

N0

M0

M0

IIA

 

T2b

T3a

N0

N0

M0

M0

IIB

 

T3b

T4a

N0

N0

M0

M0

IIC T4b N0 M0
III Any T ≥N1 M0
IV Any T Any N M1

Editorial Information

Last reviewed: 15/12/2025

Next review date: 15/12/2028

Author(s): Ashita Waterston and Gillian Price, on behalf of the Melanoma SACT group.

Version: 1.0

Reviewer name(s): Ashita Waterston, Gillian Price.