NCCN Guidelines for Patients® | Melanoma - page 78

NCCN Guidelines for Patients
Melanoma, Version 1.2014
Treatment guide
Metastatic melanoma
Chart 5.5.2
shows the recommended treatments
for metastatic melanoma. The treatment options
depend on whether or not all of the cancer can be
removed by surgery. Limited metastatic disease is
when cancer has spread to only one or a few distant
sites. It is resectable, which means it can be treated
with surgery. Widespread metastatic disease is
when cancer has spread to many distant sites. It is
unresectable, which means it can’t be treated with
For limited metastatic disease,
there are two
treatment options to choose from. The preferred
treatment option is surgery to remove the whole
tumor if possible. The other options are to begin
observation with follow-up tests or receive systemic
therapy. This may help your doctor decide if surgery is
a good option for you. After a period of observation or
systemic therapy, your doctor will repeat imaging tests
to show if there are any other metastatic cancer sites.
If the imaging tests don’t show any other cancer,
then you may have surgery to remove the metastatic
tumor. If they do show other cancer, then you will
have treatment for widespread metastatic disease.
If you have surgery, then the next treatment options
depend on whether or not all of the cancer was
removed. If all of the cancer was removed by surgery,
then you may receive additional (adjuvant) treatment,
possibly within a clinical trial. Or, you can begin
Limited stage IV
(Resectable -
cancer can be
removed with
Clinical trial, or
Chart 5.5.2 Metastatic melanoma treatment
Widespread stage IV
(Unresectable -
cancer can’t be
removed with
All cancer removed
All cancer not removed
Surgery to remove cancer
Systemic therapy,
Clinical trial, or
Best supportive care, and/or
Possible surgery and/or radiation therapy for symptoms
Treat as widespread
No other cancer
Other cancer
If cancer in brain:
Possible surgery and/
or radiation therapy
for brain metastases
Treat as widespread,
shown below
Treat with surgery,
shown above
Observe or systemic
therapy, then repeat
imaging tests
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