NCCN Guidelines for Patients® | Melanoma - page 64

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
62
5.3
Treatment guide
Regional melanoma
Chart 5.3.2
shows the recommended treatments for
stage III melanoma, also called regional melanoma.
Primary treatment is the first or main treatment used
to rid your 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). Read Part 4 on page 34
for details on each type of treatment listed in the chart
above.
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. One
option is to have a complete lymph node dissection.
The other option is to join a clinical trial testing
other options. An example of such a trial is careful
observation of the nearby (regional) lymph nodes
using ultrasound.
Stage
Primary treatment
Adjuvant treatment
Pathologic stage
III upstaged from
clinical stage I or II
(Cancer in lymph nodes
found by sentinel lymph
node biopsy)
Clinical trial,
Observation, or
Interferon alfa
Chart 5.3.2 Primary and adjuvant treatment
Stage III in-transit
(Cancer found in lymph
vessels but not in
nearby lymph nodes)
Clinical trial,
Observation, or
Interferon alfa
Clinical stage III
(Enlarged lymph nodes
found by physical exam
or imaging tests)
Clinical trial,
Observation, or
Interferon alfa, and/or
Possible radiation
therapy to nodal basin
Clinical trial, or
Lymph node dissection
Clinical trial (preferred),
Wide excision,
BCG, interferon alfa, or IL-2 injection in tumor,
Imiquimod cream,
Laser/ablative therapy,
Consider palliative radiation if unresectable,
Heated melphalan injection confined to limb, or
Systemic therapy
Wide excision with lymph node dissection
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