NCCN Guidelines for Patients® | Melanoma

68 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence If you had surgery as the primary treatment and there are no signs of cancer, your next options for adjuvant treatment are to begin observation, receive nivolumab, receive dabrafenib and trametinib if you have a BRAF V600–activating mutation, or receive interferon alfa. Observation is a period of scheduled follow-up testing to watch for cancer metastasis or recurrence. If you had treatment other than surgery and the cancer remains or is progressing, then you have the same options as listed for cancer that remains after surgery. If you had treatment other than surgery as the primary treatment and there are no signs of cancer, then you may begin observation. Next steps  If you will receive systemic therapy, see Guide 23 on page 74. Guide 18 shows the treatment options for cancer that came back in the lymph nodes near the first (primary) melanoma. This is called regional lymph node recurrence. The treatment options for regional lymph node recurrence depend on whether or not you already had a lymph node dissection. A lymph node dissection is surgery to remove some or all of the lymph nodes in the area near the tumor. Read Part 4 on page 35 for details on each treatment. If you didn’t have a lymph node dissection before, then a complete lymph node dissection is recommended to remove all of the cancer. After surgery, you may receive adjuvant treatment, and the available systemic options have increased. Your doctor will discuss the use of local and systemic treatment as adjuvant treatment options. Guide 18. Regional lymph node recurrence treatment Stage Treatment of recurrence No prior lymph node dissection ª • Complete lymph node dissection to remove all of the cancer, then adjuvant treatment Had lymph node dissection and you’re able to have surgery ª • Remove lymph node recurrence + complete lymph node dissection if incomplete before, then adjuvant treatment Had lymph node dissection and you aren’t able to have surgery ª • Systemic therapy (preferred) • Palliative radiation therapy • T-VEC injection into tumor • Best supportive care

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