NCCN Guidelines for Patients® | Melanoma - page 70

NCCN Guidelines for Patients
Melanoma, Version 1.2014
Chart 5.4.2
shows the recommended treatments
for cancer that came back in or near the site of the
first melanoma. Node-negative means that there are
no cancer cells in the lymph nodes. See page 66 for
recurrence definitions. The initial or main treatment
is called the primary treatment. Adjuvant treatment is
additional treatment given after the main one to try to
kill any remaining cancer cells and lower the chance
of recurrence. Read Part 4 on page 34 for details on
each type of treatment listed in the chart.
For persistent melanoma, or true local scar
a wide excision is recommended. A wide
excision is surgery to remove the whole tumor along
with some normal-looking tissue around its edge. The
normal-looking tissue is called the surgical margin.
The size of the surgical margin depends on the
thickness of the tumor as shown in Chart 2 on page
35. You may also have a sentinel lymph node biopsy
during surgery to remove the tumor. Any additional
treatment recommendations will be based on the
pathologic stage of the recurrence as described in
Chart 5.2.2 on page 56.
For local, satellite, and/or in-transit recurrence,
treatment within a clinical trial is preferred in all cases
if one is available. A wide excision with negative
margins is recommended if all of the cancer can
be removed. Negative margins means there are
no cancer cells in the normal-looking tissue around
Treatment guide
Persistent melanoma and nonmetastatic recurrence
Initial treatment for recurrence
Adjuvant treatment
Persistent melanoma or
true local scar recurrence
Options based on
the pathologic stage
of the recurrence
Chart 5.4.2 Node-negative recurrence treatment
Local, satellite, and/or
in-transit recurrence
Clinical trial,
Observation, or
Interferon alfa
Wide excision with possible
sentinel lymph node biopsy
Clinical trial (preferred),
Wide excision,
BCG, interferon alfa, or IL-2 injection in tumor,
Imiquimod cream,
Laser/ablative therapy,
Consider palliative radiation if unresectable,
Heated melphalan injection confined to limb, or
Systemic therapy
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