NCCN Guidelines for Patients® | Melanoma - page 53

NCCN Guidelines for Patients
: Melanoma
Version 1.2013
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Part 6: A step-by-step treatment guide
Clinical stage:
A rating of
the extent of melanoma
based on the physical
exam, imaging tests, and
biopsy of the primary tumor
The second layer
of skin that is beneath the
top layer (epidermis)
Lymph nodes:
groups of special disease-
fighting cells located
throughout the body
Doctor who’s
an expert in testing cells
and tissue to find disease
Testing to detect
a disease that isn’t causing
See Part 2 on page
16 for more test
details and definitions.
6.2 In situ and local melanoma
Part 6.2.1 describes the recommended tests for in situ and local melanoma
tumors. In situ melanoma (stage 0) is when abnormal cells are only in the
epidermis—the outer layer of the skin. Stage I and II tumors are considered
local melanoma. Local melanoma tumors have grown into both skin layers—the
epidermis and dermis—but haven’t spread anywhere else.
For in situ and local melanoma tumors, a few tests are recommended.
These include a medical history and physical exam. Imaging tests are only
recommended if you have a specific sign or symptom that your doctor needs to
check. Blood tests to screen for metastatic cancer aren’t recommended.
For stage II and some stage IA and IB melanoma tumors, it may be more likely
that cancer cells have spread to lymph nodes based on certain risk factors.
In this case, your doctor may talk to you about having a sentinel lymph node
biopsy. If needed, your doctor will likely perform the sentinel lymph node biopsy
during surgery to remove the tumor.
Next steps:
See Part 6.2.2 for recommended treatments for stages 0, I, and II
6.2.1 Tests
Clinical stage
Stage 0 (in situ)
• Medical history and physical exam,
• Imaging tests for specific symptoms, and
• Discuss possible sentinel lymph node biopsy
Stage IA
(0.76–1 mm thick)
Stage IB
(0.76–1 mm thick)
Stage II
Stage IA or IB
(≤0.75 mm thick)
• Medical history and physical exam, and
• Imaging tests for specific symptoms
• Medical history and physical exam, and
• Imaging tests for specific symptoms
mm =
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