NCCN Guidelines for Patients® | Melanoma - page 76

NCCN Guidelines for Patients
Melanoma, Version 1.2014
5.5 Metastatic melanoma
Part 5.5 explains the recommended tests and
treatments for melanoma that has spread far away
from the first (primary) tumor. This is called metastatic
melanoma. Melanoma with distant metastases when
first found (diagnosed) is stage IV cancer. However,
cancer may come back in a distant site after previous
melanoma treatment. This is called a distant
metastatic recurrence. The recommended tests and
treatments are the same for an initial diagnosis of
metastatic melanoma and for metastatic recurrence.
Chart 5.5.1
shows the recommended tests for
metastatic melanoma. The first step is to confirm
the metastatic cancer with a biopsy of one of the
distant tumors. An FNA biopsy or excisional biopsy
may be used. (Read page 17 for details on each type
of biopsy.) Your doctor may remove another tissue
sample for genetic testing if you’re thinking about
entering a clinical trial of targeted therapy. In this
case, an excisional biopsy is preferred.
A blood test to measure your LDH levels is
recommended. This test will give information about
your prognosis—the likely course or outcome of a
disease. Your doctor may also order other blood tests.
Baseline imaging tests are recommended for staging
and to check out specific symptoms. A baseline
is a starting point to which future test results are
compared. An MRI or CT scan with contrast of your
brain should be done when stage IV melanoma is first
found or if you have any signs or symptoms of cancer
in your brain or spinal cord. (Read Part 2 on page 16
for more test details.)
Treatment guide
Metastatic melanoma
Stage IV
• FNA or excisional biopsy of distant tumor,
• LDH levels, and
• Baseline imaging tests for staging and to check out
specific signs or symptoms:
-- MRI of the brain,
-- CT scan of the chest, abdomen, and pelvis, and
-- Possible PET/CT with CT scans
Chart 5.5.1 Metastatic melanoma tests
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