An Insight into the Implications of the NCCP 2024 Guideline on the Staging & Surveillance of Melanoma.

Abstract

Aim: In 2024, the NCCP introduced changes to the staging and surveillance of cutaneous melanoma. This study aims to evaluate the cost-effectiveness of this proposed change and the impact on future modelling of services. Methods: Patients diagnosed with melanoma (Clinical Stage Ib and above) treated between 2017 and 2023 at Beaumont Hospital were identified from a prospectively maintained database. Data were analysed for their journey on an idealized pathway modelled over a 5-year follow-up period according to new guidelines. The increased number and cost of surveillance imaging required was estimated and compared with previous best practice. Results: According to new guidelines, based on our patient population, an additional 110 surveillance whole-body CT and brain-CT scans could be required annually for stage IIb and IIc melanoma. Regarding PET-CT scans, this could lead to a potential additional annual expense of €176,000. An additional 390 surveillance MRI-Brain scans could potentially be required annually for stage III and IV melanoma patients. Discussion: This study identifies cost and service access implications with the implementation of these guidelines. The clinical utility of increased surveillance imaging is yet to be determined. This provides key information for planning future service delivery in the context of an aging population and increased prevalence of melanoma.

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