Objectives
  • To be able to work within a multidisciplinary team to perform diagnostics, treatment and counselling of patients with melanoma

  • To be able to identify patients at high risk for melanoma and melanoma familial syndromes as well as to perform specialist assessment, diagnostics, treatment and counselling of these patients and families

  • To understand and be able to counsel patients regarding the modifiable risk factors for melanoma

  • To understand the molecular, cellular and immunological pathology of melanoma, and its relevance for the clinical management of patients

Awareness
  • Awareness of the importance of the multimodality approach to treat patients with melanoma, including medical, surgical and radiation oncology as well as specialties such as physical therapy to manage lymphoedema, and dietetic treatment, and social work

  • Appreciation of different anatomic sites and associated behaviours (cutaneous, non-cutaneous: uveal, mucosal, unknown primary) influencing treatment strategies

  • Recognition of atypical pigmented lesions and their implications for care

  • Appreciation of different molecular profiles of melanoma and how these influence selection of treatment

  • Appreciation of stage-based treatment approaches and the existence of other prognostic factors

  • Awareness of diagnostic procedures such as sentinel lymph node biopsy, computed tomography (CT) scan, positron emission tomography (PET) scans and ultrasonography

Knowledge
  • Familiarity with the indications and different techniques for the diagnosis and characterisation of pigmented lesions (biopsy procedures, sentinel nodal evaluation, pathological evaluation, molecular profiling)

  • Familiarity with the risk of recurrence by stage and the role of adjuvant therapies

  • Familiarity with the role of surveillance examination (physical and radiological approaches and new technologies allowing for in situ evaluation of pigmented lesions)

  • Familiarity with the indications for therapy for non-operable and metastatic disease, including targeted therapy, immunotherapy, chemotherapy, surgery and radiation therapy

  • Familiarity with the indication for adjuvant therapy in high-risk melanoma

  • Familiarity with the complications and toxicity of each type of therapy and their management

  • Knowledge of the risk–benefit ratio for treatments

  • Familiarity with melanoma-associated paraneoplastic syndromes

  • Familiarity with familial and high-risk syndromes from primary melanoma and multiple primary melanomas

  • Knowledge of prevention techniques using modifiable risk factors

Skills
  • Ability to perform patient history, physical examination with lymph node and skin examination

  • Ability to perform lumbar puncture in cases of suspected carcinomatous meningitis and to either refer to the appropriate specialist or perform skin biopsies

  • Ability to actively contribute to multidisciplinary discussions establishing the diagnosis, stage and treatment plans

  • Ability to present a concise and coherent summary of the patient's condition and history of care

  • Ability to identify and manage conditions (stage, performance status, comorbid conditions, prior therapies, family history) that will influence therapeutic and care strategies

  • Ability to identify emergent/urgent conditions such as brain metastases, carcinomatous meningitis and bowel obstruction and to develop treatment approaches

  • Ability to discuss options for therapy by stage and to discuss with patients and their family the complications of targeted therapy, immunotherapy, radiation therapy and surgery as well as the role of investigational agents

  • Ability to rapidly identify specific immuno-oncology toxicities and to apply appropriate management guidelines

  • Ability to use molecular and immunohistochemical markers in helping with therapy strategies

  • Ability to address risk and benefits with the patient

  • Ability to evaluate treatment outcomes, toxicity and the management of these complications, including decision to change or end therapy

  • Ability to address family issues and prevention strategies

  • Ability to use request consultation services and co-ordination of care pathways relevant to the practice environment