NCCN Guidelines for Patients
Part 6: A step-by-step treatment guide
CT scan, and PET/CT scan every 3 to 12 months and
a brain MRI every year. These tests may be done for
up to 5 years after treatment has ended. Imaging tests
are not recommended after 5 years if there has been no
recurrence and you don’t have symptoms. Routine blood
tests to check for recurrence are not recommended.
If follow-up tests show that the cancer has come back,
treatment options will depend on the type of recurrence.
Persistent melanoma is when cancer cells remain after
surgery or other treatments. Nonmetastatic recurrence is
when cancer comes back after treatment but it has not
spread to distant sites. Metastatic melanoma is when the
cancer has spread to distant sites in the body.
For persistent melanoma or nonmetastatic
recurrence, see Part 6.4 for recommended tests and
treatments. For metastatic melanoma, see Part 6.5 for
recommended tests and treatments.
6.4 Persistent melanoma and nonmetastatic
Part 6.4 describes the recommended tests and treatments
for melanoma that came back after treatment at or near
the site of the first melanoma.
Persistent melanoma, or true local scar recurrence, refers
to cancer cells that remain after surgery or to cancer cells
not destroyed by other treatments. Persistent melanoma
is found in or right next to the scar from the surgery. It
is defined by the presence of melanoma in the most
superficial layers of the skin (epidermis or superficial
Local recurrence means the cancer returned in the
surgical scar where the first melanoma tumor was
removed. However, as opposed to persistent disease,
the cancer cells are found in the scar tissue within the
deep tissue of the dermis or subcutaneous fat. Satellite
recurrence means the cancer has come back and formed
tumors in small areas of skin near the first melanoma
tumor, but outside the scar. In-transit recurrence means
the cancer has come back and formed tumors in the lymph
vessels farther away—at least 2 cm—from the first tumor,
but not in the lymph nodes. These recurrences are called
“node-negative” because there is no cancer in the lymph
Regional lymph node recurrence means the cancer has
come back in the lymph nodes near the first melanoma.
This is also referred to as a “node-positive” recurrence.
Magnetic resonance imaging
Positron emission tomography/