NCCN Guidelines for Patients® | Melanoma - page 72

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
70
5.4
Treatment guide
Persistent melanoma and nonmetastatic recurrence
Chart 5.4.3
shows the recommended treatments
for cancer that came back in the lymph nodes near
the first (primary) melanoma. This is called regional
lymph node recurrence. The initial or main treatment
is called primary treatment. Adjuvant treatment is
additional treatment given after the main one to try to
kill any remaining cancer cells and lower the chance
of recurrence. The treatment options for regional
lymph node recurrence depend on whether or not you
had a lymph node dissection with treatment before.
A lymph node dissection is surgery to remove some
or all of the lymph nodes in the area near the tumor.
Read Part 4 on page 34 for details on each treatment.
If you didn’t have a lymph node dissection
before,
then a complete lymph node dissection is
recommended to remove all of the cancer.
If you already had a lymph node dissection
and you are able to have surgery,
then surgery
to remove the cancer (tumor excision) with negative
margins is recommended. All of the lymph nodes in
the affected area should also be removed if you didn’t
have a “complete” lymph node dissection before.
If you already had a lymph node dissection and
you are unable to have surgery
or the cancer is
widespread, you have several options. One option
is to receive treatment within a clinical trial. Other
options include radiation therapy, systemic therapy,
and supportive care. Systemic therapy options
are listed in Chart 6 on page 81. For more details,
read
Principles of systemic therapy
on page 80 and
Principles of radiation therapy
on page 79.
Previous treatment
Initial treatment for recurrence
No prior lymph
node dissection
Adjuvant treatment
Chart 5.4.3 Regional lymph node recurrence treatment
Had lymph node
dissection and you’re
able to have surgery
All cancer
removed
All cancer
not removed
Complete lymph node dissection
to remove all of the cancer
Tumor excision + complete
lymph node dissection if
incomplete before
Had lymph node
dissection and you
aren’t able to have
surgery or cancer
is widespread
Clinical trial,
Radiation therapy,
Systemic therapy, or
Best supportive care
Adjuvant treatment
Adjuvant treatment
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