Table 3 Strategies that could support clinician use of SN biopsy guideline recommendations

1.The key informants emphasised that drawing on multidisciplinary expertise not only helped clinicians to keep abreast of the latest developments in melanoma management but that it helped to overcome suspicion of the motivations of other specialties

2.Knowledge dissemination strategies need to consider the important role of professional influence on determining clinicians’ practice, as well as the complex ways in which evidence and clinical experience interact to influence practice. Knowledge dissemination approaches that engage individual healthcare professionals and local groups and leverage the influence of expert and peer opinion leaders are more likely to facilitate attitude change rather than top-down, policy-driven changes

3.State-based data on rates of sentinel node biopsy (SN biopsy) in Australia might assist in service planning for treatment of melanomas

4.The role of SN biopsy requires careful messaging, in particular:

• SN biopsy is a staging procedure, and it is accurate staging that allows the identification of patients who might benefit from systemic therapy and more intensive follow-up

• Avoiding language that frames SN biopsy as being the ‘gatekeeper’ to systemic therapies, e.g. clinicians often talk about one of the advantages of SN biopsy being that it will ‘allow’ patients access to systemic therapies. Rather, it is a staging procedure, and it is accurate staging that determines future management, including treatment with systemic therapies