NCCN Guidelines for Patients® | Melanoma - page 65

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
63
After primary treatment, there are three options for
adjuvant treatment. You can join a clinical trial, begin
observation, or receive interferon alfa. Observation is
a period of scheduled follow-up testing to watch for
cancer spread (metastasis) or return (recurrence).
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 edge of the
tumor removed during surgery. Your doctor may
consider doing a sentinel lymph node biopsy during
surgery since it is likely that the cancer has spread.
(See page 20 for lymph node biopsy details.) If the
entire tumor can’t be removed with surgery, there are
other treatment options. Local therapy options include
BCG, interferon alfa, or IL-2 injections into the tumor
or imiquimod cream rubbed onto the tumor. These are
immunotherapy drugs and may be good options if you
have only a few in-transit metastases. Laser/ablative
therapy is also a local therapy option. Your doctor
may consider palliative radiation to relieve symptoms
if the cancer can’t be removed by surgery. A regional
therapy 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. Another treatment option is
systemic therapy. Chart 6 on page 81 lists systemic
therapy options. For more details, read
Principles of
systemic therapy
on page 80.
After primary treatment for stage III in-transit
melanoma, you may have adjuvant treatment if there
are no signs of cancer. There are three options for
adjuvant treatment. You can join a clinical trial, begin
observation, or receive interferon alfa. Observation is
a period of scheduled follow-up testing to watch for
cancer metastasis or recurrence. (See Part 4 on page
34 for details on each type of treatment.)
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, there are four options for adjuvant treatment.
The three main options are to join a clinical trial, begin
observation, or receive interferon alfa. In selected
patients, radiation therapy to the area near the tumor
where the group of lymph nodes was removed (nodal
basin) may be considered. For more information, read
Principles of radiation therapy
on page 79.
Next steps:
For recommended follow-up tests after
treatment for regional melanoma, see
Chart 5.3.3.
5.3
Treatment guide
Regional melanoma
1...,55,56,57,58,59,60,61,62,63,64 66,67,68,69,70,71,72,73,74,75,...108
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