Melanoma in Situ Given Wider Berth in New Excision Guidelines
05 Apr 2018
Determining the margin of normal looking surrounding skin that should be included when treating melanoma can be a controversial topic for skin cancer clinicians. Take too little away and the potential for cancer recurrence rises. Remove too much surrounding skin and the patient is exposed to an increased risk of complications and poorer cosmesis. Finding a safe margin that achieves complete histological clearance has been one of the topics considered as part of a detailed literature review of melanoma management conducted by the Melanoma Institute of Australia in conjunction with Cancer Council Australia. The results of that review were recently published in the Medical Journal of Australia.
As part of that review the 2008 evidence-based clinical practice guidelines for the management of melanoma have been updated. The new recommendations for definitive wide local excision of primary cutaneous melanoma are:
- Melanoma in situ: 5-10mm margins
- Invasive melanoma (pT1) ≤ 1.0mm thick: 1cm margins
- Invasive melanoma (pT2) 1.01-2.00mm thick: 1-2cm margins
- Invasive melanoma (pT3) 2.01-4.00mm thick: 1-2cm margins
- Invasive melanoma (pT4) > 4.00mm thick: 2cm margins
When compared with the 2008 guidelines, the revised excision margins for invasive melanoma remain unchanged. The only modification is the excision margin for melanoma in situ; where the clinical evidence now supports a wider excision margin of 5-10mm in order optimise the chance of achieving complete histological clearance.
The updated guidelines also provide useful practice points on diagnosis and management of melanoma, such as the method of measuring total radial excision margins- a clinical point that also influences MBS item selection. Removal of skin cancer lesions has been the subject of Medicare audits in the past and clinicians should ensure strict compliance with item descriptors.
MDA National assists its Members in Medicare audits and to obtain assistance please contact us.
This blog contains general information only. We recommend you contact your medical defence organisation or insurer when you require specific advice in relation to medico-legal matters.
Doctors Let's Talk: Get Yourself A Fricking GP
Get yourself a fricking GP stat! is a conversation with Dr Lam, 2019 RACGP National General Practitioner of the Year, rural GP and GP Anesthetics trainee, that explores the importance of finding your own GP as a Junior Doctor.
25 Oct 2022
Systematic efforts to reduce harms due to prescribed opioids – webinar recording
Efforts are underway across the healthcare system to reduce harms caused by pharmaceutical opioids. This 43-min recording of a live webinar, delivered 11 March 2021, is an opportunity for prescribers to check, and potentially improve, their contribution to these endeavours. Hear from an expert panel about recent opioid reforms by the Therapeutic Goods Administration and changes to the Pharmaceutical Benefits Scheme.
14 May 2021
Diplomacy in a hierarchy: tips for approaching a difficult conversation
Have you found yourself wondering how to broach a tough topic of conversation? It can be challenging to effectively navigate a disagreement with a co-worker, especially if they're 'above' you; however, it's vital for positive team dynamics and safe patient care. In this recording of a live webinar you'll have the opportunity to learn from colleagues' experiences around difficult discussions and hear from a diverse panel moderated by Dr Kiely Kim (medico-legal adviser and general practitioner). Recorded live on 2 September 2020.
05 Oct 2020
