NCCN Guidelines for Patients® | Melanoma

63 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Regional melanoma Your doctor may also order a CT scan of your neck. He or she may also want an x-ray of your chest. This is done to asses for cancer spread in your lungs. 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. Guide 13. Response assesment and next treatment Stage III clinical satellite or in-transit Response assessment Second-line treatment Next treatment After surgery: • No evidence of disease ª • Adjuvant treatment: ◦◦ Observation ◦◦ Nivolumab ◦◦ Dabrafenib/trametinib ◦◦ Interferon alfa After surgery: • Less than complete resection ª • Systemic therapy • Local therapy: ◦◦ T-VEC, BCG, interferon alfa, or IL-2 injection in tumor ◦◦ Local ablation therapy ◦◦ Imiquimod cream ◦◦ Consider radiation therapy if unresectable • Regional therapy: ◦◦ Isolated limb infusion/perfusion with melphalan ª Clinical assessment ± imaging: • Disease remains or is progressing ª ª • Treatment options are based on response to second-line treatment Clinical assessment ± imaging: • No evidence of disease ª • Observation Guide 14. Regional melanoma follow-up Stage (no evidence of disease) Follow-up tests Stage III ª • Regular self-exam of skin and lymph nodes • 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 • Imaging tests as needed to check specific signs and symptoms • Possible imaging tests every 3 to 12 months to screen for recurrence or metastase • See Guide 10, All stages for more information on follow-up care