Melanoma--Part 2: management

#### Summary points Most melanomas that are detected and treated early are cured. However, advanced disease carries a dismal diagnosis, and timely intervention from members of the multidisciplinary skin cancer team at all stages of the disease is essential to maximise cure rates. The management of patients with incurable disease is highly specialised and requires the input of surgeons, medical and clinical oncologists, palliative care teams, and clinical nurse specialists. In the second of this two part series on melanoma we review its management from primary lesion through to metastatic disease. #### Sources and selection criteria We used Medline (1966-2008), Cochrane Library, and Embase (1980-2008) to identify studies and meta-analyses for this review. The search string included the terms melanoma, adjuvant and metastatic therapy, wide local excision, and sentinel lymph node biopsy. We accessed the websites of the National Institute for Health and Clinical Excellence, National Cancer Research Network, and National Cancer Research Institute for guidelines and current trials in the United Kingdom. In the past, suspicious lesions were often removed in primary care. However, recent national guidance recommends that patients with suspicious pigmented lesions are referred to a specialist member of the hospital based skin cancer team using the two week cancer wait procedure.1 2 This has been the subject of much debate and if fully implemented will result in a change in practice for many general practitioners. Primary melanoma is often difficult to diagnose, even for those with a specialist training. A prospective study showed …