NCCN Guidelines for Patients® | Melanoma

65 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence diagnosis. This may include an FNA, incisional biopsy, excisional biopsy, or core biopsy. During the biopsy, your doctor may remove another tissue sample for genetic testing if you might join a clinical trial or receive targeted therapy. Imaging tests may be done for baseline staging and to check out specific signs or symptoms. A baseline is a starting point to which future test results are compared. Such imaging tests may include a CT scan of your chest, abdomen, and pelvis; an MRI of your brain; and/or a PET/CT scan. Next steps  For a true local scar recurrence and a node-negative recurrence (satellite or in-transit recurrence) treatment, see Guide 16 on the next page. For regional lymph node recurrence treatment, see Guide 18 on page 68 for the next options. Guide 16 shows the treatment options for cancer that came back (recurred) in or near the site of the first melanoma. Node-negative means that there are no cancer cells in the lymph nodes. For true local scar recurrence (persistent disease), more tissue may be removed from the tumor site. This would be the normal-looking tissue that was around the primary tumor. This is called the surgical margin. Your doctor would decide how much would be removed. You may also have lymph node mapping and sentinel lymph node biopsy based on the features of the recurrence. The mapping will allow your doctor to locate the sentinel node for biopsy. Any adjuvant treatment will be based on the pathologic stage of the recurrence as described in Guide 4 on page 41. For local, satellite, and/or in-transit recurrence, systemic therapy is an option. Local therapies may also be offered. This includes a complete resection if all of the cancer can be removed. If the margins are clear this means there are no cancer cells in the normal-looking tissue around the edge of the tumor removed during surgery. Guide 15. Tests for persistent melanoma and nonmetastatic recurrence Stage Tests True local scar recurrence (persistent disease) ª • Skin biopsy to confirm • Other tests based on the features and stage of the primary tumor Local, satellite, and/or in-transit recurrence ª • Biopsy to confirm • Imaging tests to assess the extent of disease, and to check out specific signs or symptoms Regional lymph node recurrence ª