NCCN Guidelines for Patients® | Melanoma

70 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Persistent melanoma or recurrence If all of the cancer was removed with surgery, then you have several adjuvant treatment options. Your doctor may consider radiation therapy to the nodal basin—the area near the tumor where the group of lymph nodes was removed—to help prevent recurrence in the nodal basin. For more details, read about radiation therapy on page 46. You may begin observation at this time. Another option is to receive nivolumab, dabrafenib and trametinib for patients with BRAF V600 activating mutation, high-dose ipilimumab, or interferon alfa. Another option is to receive biochemotherapy. Biochemotherapy is combination treatment with chemotherapy and immunotherapy. It is a very strong treatment and may not be a good option for everyone. For metastatic melanoma, biochemotherapy consists of dacarbazine, cisplatin, vinblastine, IL-2, or interferon alfai. If all of the cancer wasn’t removed with surgery, then you also have several adjuvant treatment options. The preferred option is to receive systemic therapy. The second option is to receive palliative radiation therapy to relieve the symptoms of melanoma. Another 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 the cancer or side effects of cancer treatment. Next steps  If you will receive systemic therapy, see Guide 23 on page 74. “ At my local hospital, the initial treatment proposal was radical surgery. I sought a second opinion at a cancer center and researched the standard of care, and concluded with help that immunotherapy and participation in a clinical drug trial were the best options for me. - John, current age 35 diagnosed at age 41

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