NCCN Guidelines for Patients® | Melanoma - page 60

NCCN Guidelines for Patients
: Melanoma
Version 1.2013
Part 6: A step-by-step treatment guide
Part 6.3.2 describes the recommended treatments for
stage III regional melanoma. For pathologic stage III
melanoma that was upstaged based on the sentinel
lymph node biopsy, the tumor has already been removed.
Therefore, there are only two primary treatment options.
You could have a complete lymph node dissection or join
a clinical trial testing other options. An example of such a
trial is careful observation of the nearby (regional) lymph
nodes using ultrasound. After primary treatment, you
have three options for additional (adjuvant) treatment.
You can join a clinical trial, begin observation with follow-
up tests, or receive interferon alfa injections.
For stage III in-transit melanoma, primary treatment
within a clinical trial is preferred if one is available. If
possible, the preferred treatment is surgery to remove the
tumor(s) with negative margins. Negative margins means
there are no cancer cells in the normal-looking tissue
around the tumor removed during surgery. A sentinel
lymph node biopsy may be done during surgery since it
is likely that the cancer has spread. If the entire in-transit
tumor(s) can’t be removed with surgery, there are other
treatment options. Local treatment options include BCG
or interferon alfa injections into the tumor and imiquimod
cream rubbed onto the tumor. These are immunotherapy
drugs and may be good options if you have only a few
in-transit metastases. A regional treatment option is
isolated limb infusion/perfusion with the chemotherapy
drug melphalan. This may be a good option if you have
several in-transit metastases in one arm or leg. Other
treatment options include laser or other ablative therapy,
palliative radiation therapy, and systemic therapy. Table
5 on page 73 lists systemic therapy options. For more
information, read
Principles of systemic therapy
page 72. After primary treatment for stage III in-transit
melanoma, you have three adjuvant treatment options.
You can join a clinical trial, begin observation, or receive
interferon alfa injections.
For clinical stage III melanoma, the primary treatment
option is a wide excision of the melanoma with a
complete lymph node dissection of all affected nearby
lymph nodes. After the tumor and lymph node surgery,
you have several options for additional (adjuvant)
treatment. Options include treatment within a clinical
trial, observation, interferon alfa injections, and possible
radiation therapy to the area near the tumor where the
lymph nodes were removed (nodal basin). For more
information, read
Principles of radiation therapy
on page
74. High-dose interferon alfa for 1 year or peginterferon
alfa-2b for up to 5 years may prevent recurrence.
Next steps:
For recommended follow-up tests after
treatment for regional melanoma, see Part 6.3.3.
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