NCCN Guidelines for Patients
Part 6: A step-by-step treatment guide
6.5 Metastatic melanoma
Part 6.5 describes the tests and treatments of melanoma
that has spread far away from the first (primary) tumor.
This is called metastatic melanoma. Melanoma with
distant metastases when first diagnosed is stage IV
cancer. However, cancer may come back (recur) in a
distant site after previous melanoma treatment. This is
called a distant metastatic recurrence. The recommended
tests and treatments are the same for an initial diagnosis
of metastatic melanoma and for metastatic recurrence.
Part 6.5.1 describes the recommended tests for
metastatic melanoma. The first step is to confirm the
metastatic cancer with a biopsy of one of the distant
tumors. An FNA biopsy or excisional biopsy may be
used. Your doctor may remove another tissue sample for
genetic testing if you’re thinking about entering a clinical
trial of targeted therapy. In this case, an excisional biopsy
A blood test to measure your LDH levels is recommended.
This test will give information about your prognosis—
the likely outcome of a disease. Your doctor may also
order other blood tests. Imaging tests are recommended
for staging and to check out specific symptoms.
Recommended imaging tests include a CT scan of
your chest, abdomen, and pelvis; an MRI of your brain;
and possibly a PET/CT scan. A brain MRI or CT scan
with contrast should be done if you have any signs or
symptoms of cancer in your brain or spinal cord.
For recommended treatments for metastatic
melanoma, see Part 6.5.2.
• FNA or excisional biopsy of distant
• LDH levels, and
• Recommended imaging tests for
staging or for specific symptoms:
▪▪ CT scan of the chest, abdomen,
and pelvis; and MRI of the brain;
with or without PET/CT scan
Magnetic resonance imaging
Positron emission tomography/