97 A new study comparing skin cancer treatment guidelines across three leading nations has revealed both a high degree of agreement and striking differences in how cutaneous melanoma is managed, raising calls for a single international standard. The findings were published in the journal Clinics in Dermatology. Researchers from the University Hospital Carl Gustav Carus in Dresden examined national guidelines from Germany, the US, and Australia, analysing their approaches to diagnosing and treating melanoma up to stage IIIC. Despite broad consensus on many clinical steps, several divergences in surveillance and diagnostic protocols have prompted concern among medical professionals. While all three countries support surgical excision as the cornerstone of treatment, with recommended safety margins generally aligned with tumour thickness, differences emerge in follow-up care. One such difference lies in the use of lymph node ultrasound. Germany recommends this imaging from stage IB, aiming for early detection of regional spread, whereas Australia and the United States limit its use to cases where sentinel lymph node biopsy is unavailable or declined. Another discrepancy is seen in the inclusion of tumour marker S100B in routine surveillance. The German guidelines support its optional use from stage III, citing potential benefits in prognosis. However, the American and Australian guidelines do not endorse it, largely due to questions over its reliability and availability through national health systems. In Australia, the test is not covered by public health insurance, limiting its practical use despite theoretical advantages. In early stages of the disease, the guidelines are in near total agreement. All three advise against advanced imaging for asymptomatic patients, such as MRI, CT scans, and chest X-rays, citing a lack of benefit and the risk of false positives. This unified stance highlights a shared emphasis on balancing effective care with the risks of overtreatment. Sentinel lymph node biopsy, a procedure used to determine the extent of cancer spread, also garners unified support. The guidelines agree it should be considered for tumours at least 1 millimetre thick or slightly thinner if risk factors like ulceration or high mitotic rate are present. This consistency reflects reliance on a shared evidence base, but the study authors argue that even small variations in guidelines can lead to inconsistencies in care across borders. The authors highlight that many divergences stem not from scientific disagreement but from structural differences in healthcare systems and varying access to diagnostic technologies. They suggest that creating a unified, globally recognised set of clinical practice guidelines could reduce such disparities and improve outcomes. The need for unified guidance becomes more pressing as melanoma cases rise worldwide. With an estimated 325,000 new diagnoses and over 57,000 deaths in 2020 alone, the disease remains one of the most lethal forms of skin cancer, despite accounting for only a small percentage of overall skin cancer cases. As technological advances continue to emerge, such as optical coherence tomography for non-invasive diagnostics, the gap between regions could widen further unless a concerted international effort is made. The study concludes that harmonising melanoma care through a single set of global standards would benefit both patients and practitioners by streamlining updates and reducing regional inequality in cancer care.