NCCN Guidelines for Patients® | Melanoma - page 63

NCCN Guidelines for Patients
: Melanoma
Version 1.2013
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Part 6: A step-by-step treatment guide
Genetic testing:
Tests of
the instructions in cells for
making and controlling cells
Lymph nodes:
groups of special disease-
fighting cells located
throughout the body
Lymph vessels:
that carry lymph—a clear
fluid containing white blood
cells—throughout the body
The return of
cancer after treatment
Below the
At, on, or near
the top or surface
See page 16 for test
details and page 34
for treatment details.
Distant recurrence means the cancer has spread to tissues or organs beyond the
first melanoma and regional lymph nodes. For distant metastatic recurrence, see
Part 6.5 for recommended tests and treatments.
6.4.1 Tests
Clinical stage
• Skin biopsy to confirm, and
• Other tests based on cancer stage
Persistent melanoma or
true local scar recurrence
Local, satellite, and/or
in-transit recurrence
Regional lymph
node recurrence
• FNA or excisional biopsy, and
• Possible imaging tests for staging
or for specific symptoms
• FNA (preferred) or excisional
biopsy of enlarged lymph nodes,
• Possible imaging tests for staging
or for specific symptoms, and
• CT of pelvis if lymph nodes in groin
are enlarged
Part 6.4.1 describes the recommended tests for cancer that came back at or
near the site of the first melanoma after treatment. For persistent melanoma or
true local scar recurrence, the first recommended test is a skin biopsy to confirm
the diagnosis. A biopsy is the removal of small amounts of tissue to test for
disease. The next tests you will receive are based on the clinical cancer stage,
discussed in Part 6.2.1.
For local, satellite, and/or in-transit recurrence, the first recommended test is a
biopsy to confirm the diagnosis. Options include an FNA or excisional biopsy.
During the biopsy, your doctor may remove another tissue sample for genetic
testing if you’re thinking about joining a clinical trial of targeted therapy. Imaging
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