Further investigations and non-surgical staging

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

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.

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.

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

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.

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.