High-Risk Melanoma: Stage Before Operating

Current NICE guidelines state that in high-risk melanoma patients, imaging should not be offered before SLNB unless lymph node or distant metastases are suspected. Our experience has been that in patients with pT3b, pT4a and pT4b melanomas, the rate of management-changing findings on axial imaging prior to SLNB was high and that 'stage before operating' is a better approach. We now offer full axial imaging as staging to all high-risk melanoma patients prior to SLNB and advise other skin cancer MDTs to follow this approach.