Management of Vulval Melanoma Ewan Wilson Consultant Plastic Surgeon Skin Oncologist

Introduction About me Reason for today Guidelines Questions

Mucosal Melanoma Guidelines Taskforce from all specialties 12-18 months Draft Guidelines back from consultation

Patient Focussed Care Responsible clinician Cancer Nurse Specialist (keyworker) Information Easy access Network

MDT Discussion at both site specific and Specialist MDT Pathology reviewed by a melanoma pathologist Management agreed by both MDT’s Consultant to consultant communication Metastatic disease to be managed by Melanoma MDT

Recognition and Referral Joint Dermatology clinic Excision or punch biopsy Groin nodes – USS Core biopsy

Staging Inspection and examination Speculum Cystoscopy CT Head/Neck/Chest/Abdo/Pelvis PET CT BRAF/NRAS/CKIT

Surgery Centralised <4cm WLE with R0 margin >4cm Radical excision (vulvectomy) R0 margin Lymphadenectomy in the presence of metastases only No role for SNB

Adjuvant Treatment Systemic treatment not to be offered Consider RT for R1 margins where curative intent was intended and surgery would be deforming

Follow up Local Recurrence 3 monthly for 3 years – Inspection/palpation/speculum/cystoscopy (if indicated) Systemic Baseline CT 3 months post surgery 6 monthly staging

Follow Up Local Recurrence: 6 monthly years 4&5 Systemic: CT staging yearly Yearly 6-10 with rapid access

Metastases ECT Systemic treatment

Questions?