NCCN Guidelines for Patients® | Melanoma

57 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide In situ and local melanoma Routine blood tests to check for recurrence are not recommended. No other follow-up tests, apart from ongoing skin exams, are recommended for stage 0 (in situ) melanoma. For stage I and II melanomas, you should also have regular medical check-ups and physical exams. Your doctor will examine your lymph nodes and look carefully at your skin during the physical exam. The guide below lists the recommended exam schedule. For stage IIB and IIC melanomas, you may have imaging tests to screen for cancer recurrence or metastases. Screening means testing to detect a disease when there are no signs or symptoms present. Imaging tests for screening may be done every 3 to 12 months. This may include a CT scan of your chest, abdomen, and pelvis; MRI of your brain; and/or a PET/CT scan. Your doctor may also consider doing an x-ray of your chest to watch for cancer spread in your lungs or CT of your neck. These tests may be done for up to 3 to 5 years after treatment has ended. Routine imaging tests are not recommended after 3 to 5 years if there has been no recurrence and you don’t have any symptoms. If follow-up tests show that the cancer has come back (recurred) or spread (metastasis), treatment options will depend on the type of recurrence or metastasis. Persistent melanoma is when cancer cells remain in the skin after surgery or other treatments and does not represent a metastatic type of local recurrence. A nonmetastatic recurrence is cancer that has come back after treatment but hasn’t spread beyond the area near the first tumor. Guide 10. In situ and local melanoma follow-up Clinical stage (no evidence of disease) Follow-up tests All stages ª • Complete skin exam at least once a year for life • Regular self-exam of skin and lymph nodes • Imaging tests as needed for specific signs and symptoms • Possible regional lymph node ultrasound • Genetic counseling/testing if 3 or more invasive melanomas, or personal or family history of melanoma and certain cancers Stage IA to IIA ª • Tests listed above for all stages • Medical history and physical exam with focus on skin and lymph nodes ◦◦ Every 6 to 12 months for 5 years, then ◦◦ Every year as needed Stage IIB to IIC ª • Tests listed above for all stages • Medical history and physical exam with focus on skin and lymph nodes ◦◦ Every 3 to 6 months for 2 years, then ◦◦ Every 3 to 12 months for 3 years, then ◦◦ Every year as needed • Possible imaging tests every 3 to 12 months to screen for recurrence or metastases

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