1. Management of Vulval Melanoma
Ewan Wilson
Consultant Plastic Surgeon
Skin Oncologist

2. Introduction
About me
Reason for today
Guidelines
Questions

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

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

5. 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

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

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

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

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

10. 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

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

12. Metastases
ECT
Systemic treatment

13. Questions?