Further investigations and non-surgical staging

Recommendation: Staging contrast-enhanced computed tomography (CE-CT)should be offered to patients with stage IIB, IIC, III and IV melanoma.

Good practice point: Staging CE-CT should include head, chest, abdomen and pelvis. The neck should be included if primary drainage of the melanoma is into the head and neck.

Good practice point: Positron emission tomography–computed tomography (PET-CT)should be considered for patients after discussion with the specialist multidisciplinary team. Clinical situations where CT-PET is generally considered include patients with indeterminate findings on CE-CT, patients who are being considered for major surgical resection, and patients with in-transit disease on the limbs.

Recommendation: CE-CT of the head with contrast should generally be used as the first-line imaging modality for identifying brain metastases.

Good practice point: Clinical situations where magnetic resonance imaging (MRI) may be considered (after discussion with the specialist multidisciplinary team) include patients with indeterminate findings on CE-CT or patients being considered for locoregional treatment of brain metastases in order to identify further lesions which may alter management.

Recommendation: Routine blood tests are not indicated in staging asymptomatic patients with melanoma, with the exception of LDH in patients with stage IV disease, which is part of routine classification.