NCCN Guidelines for Patients® | Melanoma

58 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide In situ and local melanoma Metastatic melanoma is cancer that has spread from the original (primary) tumor to other parts of the body. Next steps  For persistent melanoma or nonmetastatic recurrence, see Guide 15 on page 65 for treatment options. For metastatic melanoma, see Guide 20 on page 71. Guide 11 shows the tests that are recommended for stage III (regional) melanoma. Regional melanoma has spread beyond the first (primary) tumor to nearby lymph nodes, lymph vessels, or both. Lymph nodes are small groups of special disease- fighting cells located throughout the body. Lymph vessels are tiny tubes that connect lymph nodes to each other. Lymph vessels also carry a clear fluid (lymph) containing white blood cells throughout the body. Regional melanoma has not spread to parts of the body far away from the primary tumor. The pathologic stage is based on the clinical stage as well as tests of lymph nodes and other tissue removed during surgical treatment. The clinical stage is a rating of the extent of melanoma in your body based on the physical exam and biopsy of the primary tumor. For pathologic stage IIIA, IIIB, and IIIC the sentinel lymph node biopsy found cancer in the sentinel lymph node. In this case, your doctor may use imaging tests for baseline staging and to check out specific signs or symptoms of cancer. Guide 11. Regional melanoma tests Stage Tests Stage IIIA (Cancer in lymph nodes found by sentinel node biopsy) ª • Possible imaging tests for baseline staging • Imaging tests to check out specific signs or symptoms Stage IIIB/C (Cancer in lymph nodes found by sentinel node biopsy) ª • Imaging tests for baseline staging and to check out specific signs or symptoms Clinical stage III (Enlarged lymph nodes found by physical exam or imaging tests) and Stage III clinical satellite or in-transit (Cancer cells found in lymph vessels but not in lymph nodes) ª • FNA biopsy preferred, or core, incisional, or excisional biopsy of enlarged lymph nodes • Imaging tests for baseline staging and to check out specific signs or symptoms

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