Recommendations table
Surgery
All melanoma suspected lesion must be biopsied	A	1a
Surgical margins should be Breslow adapted	A	1a
Melanomas of more than 1 mm should undergo sentinel node biopsy	A	1a
Melanomas of 0.75 mm should undergo sentinel node biopsy if there are risk factors	B	1a
Lymph node resection should be performed if sentinel node is positive or clinically evident	A	2a
Solitary metastases must be surgically removed	B	2b
Adjuvant therapy
High risk melanoma patients could receive interferon adjuvant therapy	B	1a
If surgical margins are affected adjuvant radiotherapy may be added	B	2b
Adjuvant radiotherapy should be considered if more than 3 nodes are present, one is larger than 3 cm or capsule is broken	C	1b
Locoregional disease
Palliative radiotherapy can be used in in transit metastases	C	4
Surgery can be used for in transit metastases	C	4
Isolated limb perfusion can be used for in transit metastases	C	4
T-VEC can be used in locorregional disease	B	1a
Metastatic disease
B-RAF determination should be done for all metastatic patients	A	1a
Combined B-RAF/MEK inhibition should be offered for BRAF mutated patients	A	1a
Anti-PD1 containing therapy is the first option for BRAF wild type patients	A	1a
BRAF inhibitors may be used in brain metastases	A	2a
Anti PD1 based therapy can be an alternative for BRAF mutated patients whose disease is not aggressively progressing	B	2a
Chemotherapy is an option if no other therapy could be available	A	1A
Patients treated with immunotherapy must be offered BRAF/MEK therapy as second line	A	2b
Patients treated with BRAF/MEK inhibitors must be offered anti-PD1 based therapy	A	2a
KIT mutated melanomas may be offered KIT kinase inhibitors	C	2b
NRAS mutated melanomas may be offered encorafenib	C	2b
Follow up
Ten year follow up must be offered	B	1b
Lifelong skin examination is recommended	B	3b
Self-examination is recommended	B	3b
Physical examination is recommended	A	2b
Lymph node sonogram is recommended if physical exam is not clear	A	1A