NCCN Guidelines for Patients® | Melanoma

66 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence If surgery isn’t possible, other local therapy options include T-VEC, BCG, interferon alfa, or IL-2 injections into the tumor, imiquimod cream rubbed onto the tumor, and ablative therapy. Your doctor may consider palliative radiation to relieve symptoms if the cancer can’t be removed by surgery or local ablative therapy. A regional therapy option is isolated limb infusion/perfusion with the chemotherapy drug melphalan. Next steps  For local, satellite, and/or in-transit recurrence treatment response and next treatment options, see Guide 17 on page 67. If you will receive systemic therapy, see Guide 23 on page 74. Recommended follow-up tests during observation and after treatment are based on the cancer stage. For stage 0, I, or II, see Guide 10 on page 57. For stage III, see Guide 14 on page 63. For metastatic melanoma tests, see Guide 20 on page 71. Guide 16. Node-negative recurrence treatment Stage Treatment of recurrence Adjuvant treatment True local scar recurrence (persistent disease) ª • Remove more tissue from the tumor site (for clear margins) • Possible lymph node mapping and SLN biopsy ª • Options based on the pathologic stage of the recurrence Local, satellite, and/ or in-transit recurrence ª • Systemic therapy • Local therapy: ◦◦ Complete excision to clear margins, if possible ◦◦ T-VEC, BCG, interferon alfa, or IL-2 injection in tumor ◦◦ Local ablation therapy ◦◦ Imiquimod cream ◦◦ Consider radiation therapy can’t be removed by surgery • Regional therapy: ◦◦ Isolated limb infusion/perfusion with melphalan ª • See Guide 17

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