Evidence supports the safety of Mohs micrographic surgery for melanoma. Because of its potential benefits to the patient in terms of very low-recurrence rates and same-day histologic confirmation of tumor removal with reconstruction of tumor-free margins of potentially smaller wounds, it should be one of the treatment options considered. The informed consent process for the patient should not be complete without a discussion of the attributes of Mohs surgery for melanoma.

BACKGROUND: The provision of knowledge through clinical practice guidelines and hospital-specific standard operating procedures (SOPs) is ubiquitous in the medical context and in the treatment of melanoma patients. However, these knowledge sources are only available in unstructured text form and without any contextual link to real patient data. The aim of our project is to give a modeled decision support for the next treatment step based on the actual data and position of a patient.
METHODS: First, we identified passages for qualified decision-making necessary at the point of care from the SOP for melanoma. Thereby, the patient-specific contextual reference data at decision points was considered in parallel and represented by FHIR (Fast Healthcare Interoperability Resource) resources. The decision algorithm was then formalized using BPMN modeling with FHIR annotations. Validation was provided by medical experts, dermatooncologists from University Hospital Essen.
RESULTS: The resulting BPMN model is presented here with the diagnostic procedure of sentinel lymph node excision as the example snippet from the whole algorithm. Each decision point is edited with FHIR resources covering the patient data and preparing the context sensitivity of the model.
CONCLUSIONS: Modeling guideline-based information into a decision algorithm that can be presented at the point of care with contextual reference, may have the potential to support patient-specific clinical decision-making. For patients from a certain status like in the metastatic setting modeling becomes highly tailored to specific patient cases, alternative and individualized treatment options.

Programmed cell death protein 1 (PD-1) inhibitor therapies are now a standard treatment for advanced melanoma and other tumor types. The immune-related adverse events (irAEs) associated with PD-1 inhibitor therapy are drastically different from the AEs associated with chemotherapy. Because these irAEs reflect immune system activation rather than side effects of therapy, nurses should be cognizant of the range of organ systems potentially affected as well as likely clinical presentations.
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This article presents consensus statements to guide nurses in the recognition and management of irAEs associated with PD-1 inhibitor monotherapy for advanced melanoma.
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Members of the Melanoma Nursing Initiative discussed the current literature and clinical experience regarding nursing interventions related to irAEs associated with PD-1 inhibitor therapy.
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The care step pathways provided for select irAEs represent a proactive, comprehensive nursing care plan to support optimal outcomes for patients receiving PD-1 inhibitor therapy.