NCCN Guidelines for Patients® | Melanoma - page 55

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 cancer based
on the physical exam,
imaging tests, and biopsy
of the primary tumor
Lentigo maligna
The slowest
growing type of melanoma;
often mistaken for a sunspot
Pathologic stage:
A rating
of the extent of cancer in
the body based on tests
of lymph nodes and other
tissue removed during
surgical treatment
Sentinel lymph node
Surgery to remove
the first group of disease-
fighting cells to which
cancer cells travel after
leaving the primary tumor
For thicker melanomas, you may also have a sentinel lymph node biopsy during
surgery to remove the tumor. If the biopsy finds cancer in the sentinel lymph node,
the clinical stage of the melanoma will be upstaged to pathologic stage III. In this
case, you will now be treated for stage III melanoma instead of stage I or II.
Table 4. Surgical margins for melanoma
Tumor thickness Surgical margin
In situ
0.5–1.0 cm
≤1.0 mm
1.0 cm
1.01–2.0 mm
1.0–2.0 cm
2.01–4.0 mm
2.0 cm
>4 mm
2.0 cm
Note: For melanoma in situ, lentigo maligna type, surgical margins >0.5 cm may
be needed to obtain negative margins.
For stage 0 and IA tumors and most stage IB tumors, further treatment after
surgery (adjuvant treatment) isn’t needed. Instead, you will begin observation—
a follow-up schedule to monitor for cancer growth or return (recurrence). While
most patients with stage IB and IIA melanoma are also monitored closely for
recurrence, a second option may be to join a clinical trial. A clinical trial is a type of
research on a test or treatment to assess its safety or how well it works.
For some patients with stage IIB or IIC melanoma, a third option exists, namely
to receive interferon alfa.
Next steps:
For stage 0, I, or II melanoma, see Part 6.2.3 for recommended
follow-up tests after primary or adjuvant treatment. For pathologic stage III
melanoma (upstaged based on sentinel lymph node biopsy), see Part 6.3.1.
cm =
mm =
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