NCCN Guidelines for Patients® Version Updates: Melanoma

Following are the major updates that were included in the NCCN Guidelines for Patients®: Melanoma, Version 1.2014.

  • Part 2 – Overview of cancer tests
    • Page 22 – Imaging tests
      • Added description of ultrasound
  • Part 4 – Overview of melanoma treatments
    • Page 36 – Treatment with drugs
      • Interleukin-2 (IL-2) is now an option for local therapy in addition to systemic therapy
      • Added two new targeted therapy drugs: dabrafenib and trametinib
      • Added one new chemotherapy drug: nab-paclitaxel
    • Page 40 – Radiation and ablative therapy
      • Added stereotactic radiosurgery
    • Page 43 – Side effects of cancer treatments
      • For side effects of immunotherapy, created separate lists of side effects for each immunotherapy drug
  • Part 5 – Treatment guide
    • Page 48 – 81
      • Changed format of all charts in the Treatment guide
  • Part 5.2 – In situ and local melanoma
    • Page 58 – Chart 5.2.3
      • Under "Follow-up tests" for all stages:
        • Now recommend "regular self-exam of skin" instead of "monthly self-exam of skin"
        • Added "Possible regional lymph node ultrasound"
      • Under "Follow-up tests" for stages IA, IB, and IIA:
        • Medical history and physical exam now recommended "every 6 to 12 months" instead of "every 3 to 12 months"
      • Under "Follow-up tests" for stages IIB and IIC:
        • Possible chest x-ray, CT, PET/CT scans now recommended "every 4 to 12 months" instead of "every 3 to 12 months"
  • Part 5.3 – Regional melanoma
    • Page 62 – Chart 5.3.2
      • Under "Adjuvant treatment" for stage III in-transit:
        • Added "IL-2 injection in tumor" as a new treatment option
    • Page 64 – Chart 5.3.3
      • Under "Follow-up tests":
        • Now recommend "regular self-exam of skin" instead of "monthly self-exam of skin"
        • Added "Possible regional lymph node ultrasound"
        • Possible chest x-ray, CT, PET/CT scans now recommended "every 4 to 12 months" instead of "every 3 to 12 months"
  • Part 5.4 – Persistent melanoma and nonmetastatic recurrence
    • Page 66 – Chart 5.4.1
      • Under "Tests" for persistent melanoma or true local scar recurrence:
        • Now recommend other tests "based on the features and stage of the primary tumor"
    • Page 68 – Chart 5.4.2
      • Under "Initial treatment for recurrence" for local, satellite, and/or in-transit recurrence:
        • Added "IL-2 injection in tumor" as a new option
      • Under "adjuvant treatment" for persistent melanoma or true local scar recurrence:
        • Added "Options based on the pathologic stage of the recurrence"
    • Page 72 – Chart 5.4.4
      • Under "Adjuvant treatment":
        • Added "Possible radiation therapy to nodal basin"
  • Part 5.5 – Metastatic melanoma
    • Page 76 – chart 5.5.2
      • Under "Treatment" for limited stage IV:
        • Added recommendations after surgery based on whether or not all cancer was removed
    • Page 78 – Chart 5.5.3
      • Under "Follow-up tests"
        • Now recommend "regular self-exam of skin" instead of "monthly self-exam of skin"
        • Added "Possible regional lymph node ultrasound"
        • Possible chest x-ray, CT, PET/CT scans now recommended "every 4 to 12 months" instead of "every 3 to 12 months"
    • Page 79 – Principles of radiation therapy
      • Made significant changes to the organization and text included in this section
    • Page 80 – Principles of systemic therapy
      • Added details about dabrafenib
    • Page 81 – Chart 6. Systemic therapy for advanced or metastatic melanoma
      • Under "Preferred regimens" – Added "dabrafenib" and "dabrafenib + trametinib"
      • Under "Other regimens" – Added "trametinib" and "nab-paclitaxel"