NCCN Guidelines for Patients® | Melanoma - page 65

65
NCCN Guidelines for Patients
®
: Melanoma
Version 1.2013
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Part 6: A step-by-step treatment guide
Definitions:
Excisional biopsy:
Surgery that removes the
entire tumor to test for
cancer cells
FNA biopsy:
Use of a thin
needle to remove fluid or
tissue from the body to be
tested for disease
Lymph nodes:
Small
groups of special disease-
fighting cells located
throughout the body
Sentinel lymph node
biopsy:
Surgery to remove
the first lymph node cancer
cells travel to after leaving
the primary tumor
Stage:
Rating of the extent
of cancer in the body
Systemic therapy:
Drugs
used to treat cancer cells
throughout the body
!
See page 16 for test
details and page 34
for treatment details.
Part 6.4.2 describes the recommended treatments for cancer that came back in
or near the site of the first melanoma. Node-negative means that there are no
cancer cells in the lymph nodes. See page 62 for recurrence definitions.
For persistent melanoma, or true local scar recurrence, a wide excision is
recommended. A wide excision is surgery to remove the whole tumor along with
some surrounding normal-looking tissue, called the surgical margin. The size of
the surgical margin depends on the thickness of the tumor as shown in Table 4
on page 55. You may also have a sentinel lymph node biopsy during surgery to
remove the tumor. Any additional treatment recommendations will be based on
the stage of the recurrence as described in Part 6.2.2.
For local, satellite, and/or in-transit recurrence, the treatment options are the
same as those described for in-transit melanoma in Part 6.3.2. Treatment within
a clinical trial is preferred if one is available. A wide excision with negative
margins is recommended if all of the cancer can be removed. 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 the
surgery. If surgery isn’t possible, any of the other treatments listed in the chart to
the left is an option. Table 5 on page 73 lists systemic therapy options. If there
are no signs of cancer after any of these treatments, you may choose to begin
observation with follow-up tests, enter a clinical trial, or receive interferon alfa.
A clinical trial is a type of research on a test or treatment to assess its safety or
how well it works.
Next steps:
For recommended follow-up tests based on the cancer stage,
see Part 6.2.3 or Part 6.3.3. For metastatic melanoma, see Part 6.5 for
recommended tests and treatments.
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