NCCN Guidelines for Patients® | Melanoma - page 62

NCCN Guidelines for Patients
Melanoma, Version 1.2014
Treatment guide
Regional melanoma
5.3 Regional melanoma
Part 5.3 describes the tests and treatments that are
recommended for stage III melanoma, also called
regional melanoma. Regional melanoma has spread
beyond the first (primary) tumor to nearby lymph
nodes, lymph vessels, or both. Lymph nodes are
small groups of special disease-fighting cells located
throughout the body. Lymph vessels are tiny tubes
that connect lymph nodes to each other. Lymph
vessels also carry a clear fluid (lymph) containing
white blood cells throughout the body. Regional
melanoma has not spread to parts of the body far
away from the primary tumor. (See Part 3 on page 26
for details on melanoma stages.)
Chart 5.3.1
shows the initial tests that are
recommended for stage III (regional) melanoma. The
clinical stage is a rating of the extent of melanoma in
your body based on the physical exam, imaging tests,
and biopsy of the primary tumor. The pathologic stage
is based on the clinical stage as well as tests of lymph
nodes and other tissue removed during surgical
Clinical stage I or II melanoma is upstaged to
pathologic stage III
if the sentinel lymph node
biopsy finds cancer in the sentinel lymph node. In this
case, your doctor may use baseline imaging tests for
staging and to check out specific signs or symptoms
of cancer. A baseline is a starting point to which future
test results are compared. (Read Part 2 on page 21
for more details on imaging tests.)
Clinical stage III melanoma
is when your doctor
feels enlarged lymph nodes during the physical exam
or sees them with imaging tests.
Stage III in-transit
is when cancer cells have spread into
nearby lymph vessels more than 2 cm away from
the first tumor, but not into nearby lymph nodes. For
these stages, your doctor will perform a biopsy on
the enlarged lymph nodes to test them for cancer
Clinical stage I or II upstaged
to pathologic stage III
(Cancer in lymph nodes found by
sentinel lymph node biopsy)
Possible baseline imaging tests (CT, PET/CT, MRI)
for staging and to check out specific symptoms
Chart 5.3.1 Regional melanoma tests
Clinical stage III
(Enlarged lymph nodes found by
physical exam or imaging tests)
• FNA biopsy (preferred) or excisional biopsy of
enlarged lymph nodes, and
• Baseline imaging tests (CT, PET/CT, MRI) for
staging and to check out specific symptoms
Stage III in-transit
(Cancer cells found in lymph
vessels but not in lymph nodes)
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