Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Melanoma Working Group.

Timeframes for care

Step in pathway	Care point	Timeframe
Presentation, initial investigations and referral	Signs and symptoms	Presenting symptoms should be promptly and clinically triaged with a health professional
	Initial investigations initiated by GP	If melanoma is suspected, a biopsy or excision should be done within 2 weeks of the initial consult, and results should be provided to the patient within 1 week of the biopsy
	Referral to specialist	Where appropriate, referral to a specialist should occur within 2 weeks There will be some patients where management in primary care is appropriate
Diagnosis, staging and treatment planning	Diagnosis and staging	Staging investigations should be completed within 2 weeks of the specialist’s assessment
Diagnosis, staging and treatment planning	Multidisciplinary meeting and treatment planning	Appropriate patients should be discussed at an MDM within 4 weeks of initial diagnosis
Treatment	Surgery	Surgery in a primary care setting should occur within 2 weeks of the decision that it is necessary
	Radiation therapy	If not urgent, radiation therapy should begin within 4 weeks of the MDM Some patients will require urgent treatment
	Systemic therapy	If systemic therapy is to be given as adjuvant therapy, this should occur within 12 weeks of the definitive surgery If systemic therapy is to be given to treat stage IV disease, therapy should begin as soon as possible (as clinically indicated), ideally within 4 weeks

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

In Australia melanoma was estimated to be the third most commonly diagnosed cancer in 2020 (Cancer Australia 2020b). In 2019, Australian women were estimated to have a one in 21 chance of being diagnosed with melanoma before the age of 85, whereas men were estimated to have a one in 14 risk (AIHW 2019).

This pathway covers cutaneous melanomas. Ocular and periocular melanomas are not included in this pathway given the differences in the risk factors and management of these tumours.