Implications of systemic adjuvant melanoma treatments for U.K. melanoma services: Results of the U.K. Melanoma Adjuvant Pathway Survey.

OBJECTIVE:To understand current U.K. management pathways for patients with resected stage III melanoma and changes expected with the routine availability of systemic adjuvant melanoma treatments. METHODS:In April-May 2018 (pre-National Institute for Health and Care Excellence approval of adjuvant therapy), 49 structured interviews were conducted with U.K. health professionals involved in melanoma management (28 oncology, 12 dermatology and 9 surgery) from 34 geographically dispersed National Health Service Trusts (1-6 respondents/Trust). RESULTS:Respondents expect to see a median of 5 (range 1-35) patients/month eligible for adjuvant therapy. Currently, 31 (63%) respondents include standardised BRAFV600 mutation testing for primary melanoma in their local guidelines; 30 (61%) respondents are from centres offering sentinel lymph node biopsy (SLNB) on-site after excision of melanoma from the trunk/limbs; 21 (43%) after excision of head/neck melanoma. Referral for SLNB (if not performed on site) is not always offered. With systemic adjuvant treatments becoming routinely available, respondents expect oncology involvement in patient care to increase considerably. Significant impacts are predicted on staffing, training, commissioning, service structure, local guidelines and patient psychological support requirements. CONCLUSION:The routine availability of systemic adjuvant melanoma treatments is expected to have wide-ranging implications for the commissioning, organisation and delivery of melanoma services.