title: Melanoma - a management guide for GPs.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Surgery (Melanoma and Surgical Oncology), University of Sydney, Melanoma Institute Australia and Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, New South Wales.
authors: John F
authors: JF
authors: Thompson
authors: Richard A
authors: RA
authors: Scolyer
authors: Richard F
authors: RF
authors: Kefford
mesh_terms: D001315:Australia; D001706:Biopsy / Q000379:methods; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery