NCCN Guidelines for Patients® | Melanoma - page 70

NCCN Guidelines for Patients
: Melanoma
Version 1.2013
Part 6: A step-by-step treatment guide
For limited metastatic disease, the preferred treatment
option is surgery to remove the whole tumor if possible.
After surgery, you may join a clinical trial or start
observation. If there is only one metastatic site in the
visceral organs, the other treatment option is to start
observation with follow-up tests or systemic therapy. This
may help your doctor decide if surgery is a good option
for you. After a period of observation or systemic therapy,
your doctor will repeat imaging tests to show if there are
any other metastatic cancer sites. If the imaging tests don’t
show any other cancer, you may have surgery to remove
the metastatic tumor. If there are no signs of cancer after
surgery, you can receive additional (adjuvant) treatment
within a clinical trial or as standard of care, or you may
start observation. If the imaging tests showed other
cancer, or if there are signs of cancer after surgery, you will
receive treatment for widespread metastatic disease.
For widespread metastatic disease, the treatment
options depend on whether or not there are metastases
in your brain. If you don’t have any brain metastases,
the treatment options include systemic therapy, a clinical
trial, or best supportive care. Systemic therapy regimens
are listed in Table 5 on page 73. For more information,
Principles of systemic therapy
on page 72. Another
option is to have surgery and/or radiation therapy to treat
symptoms caused by the cancer. For more information,
Principles of radiation therapy
on page 74. This
may be used alone or in addition to one of the first three
treatment options listed. If you have brain metastases, you
will likely receive treatment for the cancer in your brain
first to try to prevent other serious medical conditions. This
may include surgery and/or radiation therapy. After treating
the brain metastases, the next treatment options are the
same as those described above for widespread metastatic
disease without brain metastases. (For more information
on treating cancer in the brain and spinal cord, see the
NCCN Guidelines for Central Nervous System Cancers.
These guidelines are available online at They
were written for your doctor, so he or she will likely be able
to answer your questions about treatment.)
Next steps:
For recommended follow-up tests after
completing treatment for metastatic melanoma, see
Part 6.5.3.
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