NCCN Guidelines for Patients® | Melanoma

67 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence Guide 17 shows treatment response and further treatment options for a local, satellite, and/or in- transit recurrence. After initial treatment for the recurrence, your doctor will give imaging tests to check how well treatment worked. An outcome or improvement caused by treatment is called a treatment response. Based on these tests, you may have further treatment. Guide 17. Node-negative recurrence response and next treatment Stage Response Second-line treatment Next treatment Local, satellite, and/or in-transit recurrence 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 not given before • Regional therapy: ◦◦ Isolated limb infusion/perfusion with melphalan • Treatment options are based on response to second-line treatment After other treatment, not surgery: • Clinical assessment ± imaging shows disease remains or is progressing ª After other treatment, not surgery: • Clinical assessment ± imaging shows no evidence of disease ª • Observation