NCCN Guidelines for Patients® | Melanoma - page 59

NCCN Guidelines for Patients
: Melanoma
Version 1.2013
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Part 6: A step-by-step treatment guide
Lymph nodes:
groups of special disease-
fighting cells located
throughout the body
Lymph vessels:
that carry a clear fluid
containing white blood cells
throughout the body
Sentinel lymph node
Surgery to remove
the first group of special
disease-fighting cells to
which cancer cells travel
after leaving the tumor
Grouping of
cancer based on tumor size
and how far the cancer has
spread in the body
See page 16 for test
details and page 34
for treatment details.
6.3.2 Primary and adjuvant treatment
Stage III in-transit
(Cancer cells found
in lymph vessels but
not in lymph nodes)
Adjuvant treatment
Primary treatment
Clinical trial, or
Lymph node
Clinical trial (preferred),
Palliative radiation if cancer
can’t be removed by surgery,
Heated melphalan injection
confined to limb, or
Wide excision with possible
sentinel lymph node biopsy,
BCG or interferon alpha
injection into tumor,
Laser/ablative therapy,
Imiquimod cream,
Systemic therapy
Clinical trial,
Observation, or
Interferon alfa
Wide excision
with lymph node
Clinical trial, or
Observation, or
Interferon alfa, and/or
Possible radiation
therapy to nodal basin
Clinical trial,
Observation, or
Interferon alfa
Clinical stage I or II upstaged
to pathologic stage III
(Cancer in lymph nodes
found by sentinel lymph
node biopsy)
Clinical stage III
(Enlarged lymph nodes
found by physical exam
or imaging tests)
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