My Myles Smith, chair of the Ano-uro-genital Mucosal Melanoma Guidelines, made this statement following the completion of the updated guidelines 2026:
‘Ano-uro-genital mucosal melanoma is rare, biologically distinct from cutaneous melanoma and frequently diagnosed at an advanced stage. Its rarity means that the evidence base is limited and patients have historically experienced variation in diagnosis, treatment and follow-up. This updated UK guideline brings together the best available evidence and multidisciplinary expert consensus to provide a clearer and more consistent framework for the care of patients with anorectal, vulvo-vaginal and urogenital mucosal melanoma.
The guideline contains important updates across the whole patient pathway.
It strengthens recommendations on the recognition and referral of both pigmented and non-pigmented lesions, pathological assessment, molecular profiling and staging, including the use of PET-CT and brain imaging. It also provides updated guidance on surgery, lymph-node assessment, adjuvant and neoadjuvant systemic therapy, surveillance, and the management of metastatic and oligometastatic disease.
A central theme is that treatment should be individualised and agreed through both the specialist melanoma and anatomical-site multidisciplinary teams. Surgery should be proportionate, with careful consideration of organ preservation, function, quality of life and patient preference, rather than an automatic move towards radical resection. Sentinel lymph-node biopsy should be considered selectively, where it is technically feasible and likely to influence management.
The guideline also places greater emphasis on patient-focussed care, including access to reliable disease-specific information, clear coordination between specialist and primary-care teams, and support for psychological, psychosexual and survivorship needs.
We hope that the guideline will reduce variation in practice, support informed discussions between patients and clinicians, and strengthen collaboration between specialist centres. It also identifies major areas of unmet need, particularly the development of better staging systems, increased inclusion of patients with mucosal melanoma in clinical trials and further evaluation of novel treatments.’
Professor Kevin Harrington, Chair of the Head & Neck Mucosal Melanoma Guideline Development Group, said:
‘Head & Neck Mucosal Melanoma (HNMM) is a rare condition that can be devastating and life-changing for patients, as well as for their families and friends. However information about the disease is scarce and mostly based on experience of melanoma in general, or of the common types of cancer that involve the head and neck. There have been very few randomised controlled trials that involve patients with HNMM when compared with melanoma affecting the skin. Therefore, there is only a small evidence-base with which to work. In the face of these challenges, the GDG was forced to draw on evidence that came almost exclusively from observational studies. In reviewing and evaluating these sources, a series of PICO questions was used to impose the necessary scientific rigour on the process.
The product of these exhaustive deliberations – the HNMM Guideline – will endure for many years and will be updated regularly under Melanoma Focus auspices. It will help clinicians in the UK and beyond to understand how to diagnose and treat this often deadly disease. These conclusions are also intended for use by patients, with a lay version written in non-scientific language produced to accompany the main document.
Especially in a situation where there was a dearth of hard scientific evidence, the skill of the GDG members was paramount – both in interpreting the limited data and in drawing on their own clinical experience of treating people suffering from this disease. The members of the group gave freely of their time in a complex task that took them away from their already busy working lives. They did this generously and on an entirely pro bono basis, aided by valuable input from patient and carer representatives.
I wish to record my thanks to all those involved – clinicians, nurses, patients, as well as to the many organisations and individuals who contributed their wisdom and knowledge in reviewing our findings during the consultation process. I also wish to extend my thanks to the team at Melanoma Focus for having the vision to commission these guidelines and for its support in facilitating meetings and during the process of drafting the guideline documents.’
