NCCN Guidelines for Patients® | Melanoma - page 58

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
56
5.2
Treatment guide
In situ and local melanoma
Chart 5.2.2
shows the recommended treatments for
stage 0, I, and II melanomas. Primary treatment is the
first or main treatment used to rid the body of cancer.
Adjuvant treatment is additional treatment given
after the main one to try to kill any remaining cancer
cells and lower the chance of cancer recurrence
(return). For local melanomas of stage 0, IA, or IB,
the chance of metastasis or recurrence is low. Thus,
surgery to remove the primary tumor may be the only
treatment needed. However, some local melanomas
may have certain features that increase the chance
of metastasis or recurrence. For these melanomas,
additional treatments may be needed.
Primary treatment
For stage 0, I, and II melanomas, the primary
treatment is a wide excision.
A wide excision
is a surgery to remove the whole tumor and some
normal-looking tissue around its edge. The normal-
looking tissue is called the surgical margin. The
size of the surgical margin depends mostly on the
thickness of the tumor. (See page 35 for more details
about surgical margins for melanoma.) For lentigo
maligna melanoma, wider margins may be needed,
particularly on the face.
Under certain circumstances, surgery may not be
possible for melanoma in situ, particularly lentigo
maligna type on the face. In such cases, your doctor
may discuss other treatment options. These may
Clinical stage
Primary treatment
Adjuvant treatment
Stage 0
Stage IA or IB
(<0.75 mm thick)
Observation
Chart 5.2.2 Primary and adjuvant treatment
Stage IA
(0.76–1 mm thick)
Observation
Stage IB
(0.76–1 mm thick)
Stage IIA
Clinical trial, or
Observation
Stage IIB or IIC
Wide excision
Wide excision + sentinel
lymph node biopsy
Wide excision + sentinel
lymph node biopsy
Wide excision + sentinel
lymph node biopsy
Clinical trial,
Observation, or
Interferon alfa
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