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Melanoma — UKMLA MCQ

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HardDermatologyMelanomaUKMLAMRCP Part 1PARA

Excision biopsy confirms cutaneous melanoma with Breslow thickness 0.9 mm and ulceration, with no clinical nodal disease. Wide local excision is planned. Which staging discussion is appropriate under NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Discuss sentinel-node biopsy because this represents ulcerated pT1b melanoma

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

E is correct because NICE advises considering sentinel-node biopsy in pT1b melanoma of 0.8–1.0 mm when adverse features such as ulceration are present. A ignores the pT1b risk feature. B is not performed without evidence of nodal metastasis and completion dissection is not routine even after a positive sentinel node. C overuses imaging in thin localised disease. D forfeits prognostic staging until clinically apparent progression.

Reference: NICE NG14, melanoma assessment and management: https://www.nice.org.uk/guidance/ng14/chapter/recommendations