NCCN Guidelines for Patients® | Melanoma - page 68

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
66
5.4 Persistent melanoma and nonmetastatic recurrence
Part 5.4 describes the recommended tests and
treatments for melanoma that came back after
treatment at or near the site of the first (primary)
melanoma.
Persistent melanoma, or true local scar
recurrence,
refers to cancer cells that remain after
surgery or to cancer cells not destroyed by other
treatments. Persistent melanoma is found in or right
next to the scar from the surgery to remove the
primary melanoma. It is defined by the presence of
melanoma in the most superficial layers of the skin
(epidermis or superficial dermis).
Local recurrence
means the cancer returned in the
surgical scar where the primary melanoma tumor was
removed. However, as opposed to persistent disease,
the cancer cells are found in the scar tissue within the
deep tissue of the dermis or subcutaneous fat.
Satellite recurrence
means the cancer has come
back and formed tumors in small areas of skin less
than 2 cm away from the first melanoma tumor, but
outside the scar.
In-transit recurrence
means the cancer has come
back and formed tumors in lymph vessels more than
2 cm away from the first tumor, but not in the lymph
nodes. These are called “node-negative” recurrences
because there is no cancer in the lymph nodes.
Regional lymph node recurrence
means the
cancer has come back in the lymph nodes near the
first melanoma. This is also referred to as a “node-
positive” recurrence.
Distant recurrence
means the cancer has come
back in tissues or organs far beyond the first
melanoma and regional lymph nodes. For distant
metastatic recurrence, see Part 5.5.
5.4
Treatment guide
Persistent melanoma and nonmetastatic recurrence
Stage
Tests
Persistent melanoma or
true local scar recurrence
• Skin biopsy to confirm, and
• Other tests based on the features and stage of the primary tumor
Chart 5.4.1 Tests for persistent melanoma and nonmetastatic recurrence
Local, satellite, and/or
in-transit recurrence
• FNA or excisional biopsy, and
• Baseline imaging tests (CT, PET/CT, MRI) for staging and to check
out specific signs or symptoms
Regional lymph
node recurrence
• FNA biopsy (preferred) or excisional biopsy of enlarged lymph nodes,
• Baseline imaging tests (CT, PET/CT, MRI) for staging and to check
out specific signs or symptoms, and
• CT of pelvis if lymph nodes in groin are enlarged
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