NCCN Guidelines for Patients® | Melanoma

54 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Melanoma testing Guide 8 shows the tests that are recommended for in situ and local melanoma. The clinical stage is a rating of the extent of melanoma in your body based on tests done before surgery. In situ melanoma—stage 0—is when melanoma cells are only in the outer layer of the skin (epidermis). Local melanoma includes stages I and II. Local melanoma tumors have grown into both skin layers— the epidermis and dermis, the second layer of skin. But, these melanomas haven’t spread anywhere beyond the skin. A few tests are recommended for all in situ and local melanoma tumors. These include a medical history and physical exam. Imaging tests take pictures of the inside of the body. They are only recommended if you have a concerning sign or symptom that your doctor needs to check. (Read page 25 for imaging test details.) Routine imaging and blood tests are not recommended without specific signs or symptoms. For stage II and some thicker stage IB melanoma tumors, it may be more likely that cancer cells have spread to lymph nodes based on certain risk factors. Therefore, your doctor may talk to you about having a surgical test called a sentinel lymph node biopsy. Lymph nodes are groups of special disease-fighting cells located throughout the body. The sentinel lymph node is the first lymph node to which cancer cells are likely to spread from the primary tumor. A sentinel lymph node biopsy is a surgery that removes the sentinel lymph node(s) to test for cancer cells. If cancer cells are found in the sentinel lymph node, it may be more likely that cancer has spread to other nearby lymph nodes or tissue. If needed, your doctor will likely perform the sentinel lymph node biopsy during treatment with surgery to remove the tumor. Guide 8. Tests for in situ and local melanoma Clinical stage Tests • Stage 0 (in situ) • Stage IA (<0.8 mm thick, no ulceration) ª • Medical history • Physical exam • Imaging tests (CT, PET/CT, MRI) for specific signs or symptoms only • Stage IB (T1b [<0.8 mm thick with ulceration or 0.8–1.0 mm thick ± ulcertaion]) • Stage IB (T2a [>1.0–2.0 mm without ulceration]) • Stage II (>1.0 mm thick, any feature, N0) ª • Medical history • Physical exam • Imaging tests (CT, PET/CT, MRI) for specific signs or symptoms only • Possible SLN ( s entinel l ymph n ode) biopsy