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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Textbook/Oncology and palliative care/Melanoma/Rapid
RapidMLAMSRAFoundation

Melanoma

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Neurological metastasis or severe systemic-treatment toxicity

Seizure, focal deficit, raised intracranial pressure, spinal-cord compression, shock or severe immune-mediated myocarditis, pneumonitis, colitis, hepatitis, endocrinopathy or neurological toxicity requires immediate rescue.

Action: Use ABCDE care, withhold systemic therapy, obtain urgent brain or spine imaging and organ-directed tests, involve acute oncology, neurosurgery, radiotherapy and critical care and start protocol corticosteroid, hormone replacement, anticonvulsant or decompressive treatment without waiting for elective melanoma review.

Synopsis

Recognise suspicious pigmented and non-pigmented lesions, obtain a full-thickness diagnostic excision, use Breslow and nodal risk correctly and coordinate wide excision, sentinel staging, adjuvant treatment and advanced immune or targeted therapy.

  • Use ABCDE for asymmetry, border, colour, diameter and evolution, plus the ugly-duckling sign; for nodular lesions remember elevated, firm and growing because colour may be absent.
  • First-line specialist assessment combines full-skin and regional-node examination with dermoscopy and comparison with photographs where available.
  • The diagnostic reference standard for a lesion suspicious for melanoma is full-thickness complete excision with a narrow approximately 2 mm clinical margin and a cuff of subcutaneous fat.

Key red flags

A changing asymmetric lesion with irregular border, colour variation, increasing diameter or evolution requires urgent dermoscopic assessment.

Distant metastatic disease

Headache, seizure, cough, liver symptoms, bone pain, bowel bleeding or multiple subcutaneous nodules can reveal systemic melanoma.

Investigation priorities

01
First-line dermoscopic full-skin assessmentFirst stepFirst line

Identify malignant structures, compare the lesion with the patient’s naevus pattern and examine regional nodes and entire skin.

Management branches

Suspicious lesionExcise narrowly for diagnosis

A pigmented or non-pigmented lesion is changing, ugly-duckling, elevated, firm or persistently growing.

  1. Take evolution, sun, immune, personal and family history and perform dermoscopic full-skin and nodal examination with photographs and measurements.
  2. Arrange urgent full-thickness complete excision with an approximately 2 mm clinical margin, using specialist incisional sampling only when site or size makes complete excision harmful.

Key medicines

PembrolizumabGive pembrolizumab 200 mg intravenously every 3 weeks or 400 mg every 6 weeks for the licensed adjuvant or advanced melanoma indication, continuing to the protocol duration or stopping for progression or unacceptable toxicity.
Dabrafenib with trametinibGive dabrafenib 150 mg orally twice daily plus trametinib 2 mg orally once daily on an empty stomach within the licensed BRAF V600-mutated adjuvant or advanced melanoma indication.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom