NCCN Guidelines for Patients® | Melanoma

69 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence If you already had a lymph node dissection and you are able to have surgery, then surgery to remove the cancer (tumor excision) with negative margins is recommended. All of the lymph nodes in the affected area should also be removed if you didn’t have a “complete” lymph node dissection before. After surgery, you may have adjuvant treatment. Your doctor will discuss the use of local and systemic treatment as adjuvant treatment options. If you already had a lymph node dissection and you are unable to have surgery or the cancer is widespread, you have several options. The first and preferred option is to receive systemic therapy. The second option is to receive palliative radiation therapy. The third option is to receive the immunotherapy drug T-VEC as an injection into the tumor. Another option is to receive best supportive care. Supportive care is treatment to relieve the symptoms caused by cancer and side effects of cancer treatment. See page to read more about supportive care. Next steps  If you will receive systemic therapy, see Guide 23 on page 74. Guide 19 shows the options for adjuvant treatment after surgery for regional lymph node recurrence. Adjuvant treatment is additional treatment given after the main one to try to kill any remaining cancer cells and lower the chance of recurrence. Guide 19. Regional lymph node recurrence adjuvant treatment Treatment of recurrence Adjuvant treatment All cancer was removed ª • Local therapy: ◦◦ Possible radiation therapy to nodal basin in certain high-risk patients • Systemic therapy: ◦◦ Observation ◦◦ Nivolumab ◦◦ Dabrafenib/trametinib ◦◦ High-dose ipilimumab ◦◦ Interferon alpha ◦◦ Biochemotherapy All of the cancer was not removed ª • Systemic therapy (preferred) • Palliative radiation therapy • T-VEC injection into tumor • Best supportive care