NCCN Guidelines for Patients® | Melanoma

61 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Regional melanoma A regional therapy option is isolated limb infusion/ perfusion with the chemotherapy drug melphalan. The drug is infused into the arm or leg during a surgical procedure. This may be a good option if you have several in-transit metastases in one arm or leg. Next steps  If you will receive systemic therapy, see Guide 23 on page 74. For follow-up tests that are recommended during observation and after treatment for regional melanoma, see Guide 14 on page 63. Guide 12. Primary and adjuvant treatment Stage Primary treatment Adjuvant treatment Stage IIIA/B/C (Cancer in lymph nodes found by sentinel node biopsy) ª • Active lymph node basin surveillance • Complete lymph node dissection ª • Observation • Nivolumab (IIIB/C) • Dabrafenib/trametinib • High-dose ipilimumab • Interferon alfa Clinical stage III (Enlarged lymph nodes found by physical exam or imaging tests) ª • Wide excision of primary tumor + complete therapeutic lymph node dissection ª • Radiation therapy to lymph node basin for certain high-risk patients • Observation • Nivolumab • Dabrafenib/trametinib • High-dose ipilimumab • Interferon alfa • Biochemotherapy Stage III clinical satellite or in-transit (Cancer in the skin near the first tumor or cells found in lymph vessels but not in lymph nodes) ª • Systemic therapy • Local therapy: ◦◦ Complete surgical excision to clear margins if possible ◦◦ T-VEC, BCG, interferon alfa, or IL-2 injection in tumor ◦◦ Imiquimod cream ◦◦ Consider radiation therapy if can't be removed by surgery • Regional therapy: ◦◦ Isolated limb infusion/ perfusion with melphalan ª • See Guide 13