NCCN Guidelines for Patients® | Melanoma

73 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Metastatic melanoma After treating the brain metastases, you can move on to the main treatment options for widespread metastatic disease. These options are the same regardless of brain metastases. There are four options for treating widespread metastatic disease. The first option is to receive systemic therapy. The second option is to receive the immunotherapy drug T-VEC as an injection into the tumor. The third option is to consider palliative surgery and/or radiation therapy to relieve the symptoms caused by the cancer. Palliative treatment can be given alone or in addition to the other options. The fourth option is to receive best supportive or palliative care. For more about supportive care, see page 47. Next steps  For systemic therapy options, see Guide 23 on page 74. See Guide 22 on page 73 for follow-up tests after completing treatment for metastatic melanoma. Guide 22 shows the follow-up tests that are needed after completing treatment for metastatic melanoma. Follow-up tests are used to monitor you after treatment to check for cancer return (recurrence) or spread (metastasis). These tests are important if you were treated for stage IV melanoma and have no current signs of cancer. A complete skin exam by your doctor is recommended every year for life. In addition, you should also examine your own skin and lymph nodes on a regular basis. You should also have regular medical history check-ups and physical exams. During the physical exam, your doctor will carefully examine your lymph nodes and skin. Imaging tests are recommended to check out specific signs or symptoms of cancer. You may also have imaging tests to screen for cancer recurrence or metastases. Screening means testing to detect a disease when there are no signs or symptoms present. Depending on the stage of your initial melanoma or extent of recurrent disease, you may undergo imaging tests for screening every 3 to 12 months. Guide 22. Metastatic melanoma follow-up testing Stage (no evidence of disease) Follow-up tests Stage IV ª • Regular self-exam of skin and lymph nodes • Medical history and physical exam with focus on skin and lymph nodes ◦◦ Every 3 to 6 months for 2 years, then ◦◦ Every 3 to 12 months for 3 years, then ◦◦ Every year as needed • Imaging tests as needed to check specific signs and symptoms • Possible imaging tests every 3 to 12 months to screen for recurrence or metastases • See Guide 10, All stages for more follow-up care