Background:
The Clinical practice guidelines for the management of cutaneous melanoma in Australia and New Zealand is endorsed by the Australian National Health and Medical Research Council, and reviewed by a consortium of experts. The guidelines form an important basis for guiding diagnosis, management and follow up of melanoma in Australia. Recommendations appear more controversial and variable where there is a lack of level 1 evidence in scientific literature.
Method:
The current melanoma guidelines were analysed to determine the evidence-base guiding consensus recommendations. The analysis for this review was based on the evidence summaries included in the guidelines which are graded from I-IV, based on National Health and Medical Research Council (NHMRC) additional levels of evidence and grades for recommendations for developers of guidelines, and the grading of evidence-based recommendations (A-D). The grading of evidence-based recommendations was summarised and reviewed. The quality of the recommendation was assessed in terms of primary evidence and explicit grading of recommendations according to the quality of supporting evidence.
Conclusion:
It is clear that certain recommendations from current melanoma guidelines are impacted by a lack of high-level supporting data. Many of the recommendations are more of a consensus statement from a panel of experts with acknowledged gaps in their supporting evidence. This raises doubts as to whether current guidelines are optimal in addressing melanoma morbidity and mortality. This has important implications for; the direction and design of further studies, medicolegal implications of guidelines, education of medical practitioners in optimal utilisation of guidelines when managing their patients. Safety and efficacy of melanoma treatment in Australia is of the utmost importance and pursing the best standards of care is the aim of this review.