NCCN Guidelines for Patients® | Melanoma

64 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence Routine blood tests to check for recurrence are not recommended. If follow-up tests show that the cancer has come back (recurred), treatment options will depend on the type of recurrence. Persistent melanoma is when cancer cells remain after surgery or other treatments. A nonmetastatic local recurrence at the initial melanoma scar site means that cancer came back in the skin after treatment but hasn’t spread beyond the area near the first tumor. This is generally treated with additional surgery at the scar site. Metastatic melanoma is cancer that has spread to parts of the body far from the first tumor. The next set of Guides describe the recommended tests and treatments for melanoma that came back after treatment at or near the site of the first (primary) melanoma. Persistent melanoma or recurrence Persistent melanoma, or true local scar recurrence refers to cancer cells that remain after surgery or to cancer cells not destroyed by other treatments. Persistent melanoma is found in or around the scar from the surgery to remove the primary melanoma. It is defined by the presence of melanoma in the most superficial layers of the skin (epidermis or superficial dermis). This usually presents as a return of color (pigment) in or around the melanoma scar. Local (metastatic) recurrence means the cancer returned in the surgical scar where the primary tumor was removed due to involvement of underlying lymph channels (intralymphatic metastasis). However, as opposed to persistent disease, the cancer cells are found in the scar tissue within the deep tissue of the dermis or subcutaneous fat. This usually presents as a firm bump in or around the melanoma scar. This can occur in the scar (called “satellite” recurrence) or between the scar and the regional lymph node basin. Satellite recurrence is a type of local recurrence. It means the cancer has come back and formed tumors in lymph vessels in the skin, deep within the scar, or just outside of the scar site. In-transit recurrence means the cancer has come back and formed tumors in the lymph vessels between the melanoma scar site and the regional lymph nodes, but not in the lymph nodes themselves. Regional lymph node recurrence means the cancer has come back in the lymph nodes near the first melanoma. This is also referred to as a “node- positive” recurrence. Distant recurrence means the cancer has come back in tissues or organs far beyond the first melanoma and regional lymph nodes. For distant metastatic recurrence, see Guide 21 on page 72 for recommended tests. Guide 15 shows the tests that are needed for cancer that has come back after treatment and is at or near the site of the first (primary) melanoma. For true local scar recurrence (persistent disease), the first recommended test is a skin biopsy to confirm the diagnosis. A biopsy is the removal of small amounts of tissue from your body to test for disease. The next tests you will receive are based on the stage and features of the recurrent melanoma tumor in the skin. For local, satellite, and/or in-transit recurrence, and regional lymph node recurrence the first recommended test is a biopsy to confirm the

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