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NCCN Quick Guide
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Melanoma
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Version 1.2016
1.2015
This NCCN Quick Guide sheet summarizes key points from the complete NCCN Guidelines for
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Patients®: Melanoma. These guidelines explain which tests and treatments are recommended by
experts in cancer. To view and download the guidelines, visit NCCN.org/patients or, to order printed
copies, visit Amazon.com.
NCCN Guidelines
for Patients®
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What is melanoma?
Melanoma is a cancer that starts in cells called melanocytes. Melanocytes are found in the lower
part of the top layer of the skin called the epidermis. Melanoma can spread to (invade) the lower
part of the skin, called the dermis, to reach nearby tissues and other parts of the body.
Doctors use several types of tests to find and confirm (diagnose) melanoma.
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How do doctors rate melanoma growth to plan treatment?
■ Cancer staging is how doctors assess and rate the extent of the cancer. The cancer stage is
based on the growth and spread of the primary tumor. It’s used to plan treatment.
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■ Stage 0: The melanoma cancer cells are only in the outer layer of skin called the epidermis.
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■ Stage I: The tumor is no more than 2.0 mm thick and may or may not have ulceration.
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■ Stage II: The tumor is 1-2 mm thick with ulceration or is >2 mm with or without ulceration.
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■ Stage III: Melanoma has spread to nearby lymph vessels, nodes, and/or nearby skin (satellites).
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■ Stage IV: Melanoma has spread far from the first tumor to distant sites in the body.
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What treatments are used for melanoma?
■ Many types of treatments are used for melanoma.
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■ Surgery, a wide excision, is often used as the main (primary) treatment to remove the cancer.
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■ Systemic therapy is the use of drugs, like immunotherapy, to treat cancer throughout the body.
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■ Supportive care is treatment for the symptoms caused by cancer.
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■ A clinical trial is a type of research that studies how safe and helpful a test or treatment is.
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What are the main treatment options for local melanoma?
Stage 0, I,
and II
NCCN QUICK GUIDE
Melanoma, Version 1.2016
■ The main treatment is a wide excision ± sentinel lymph node biopsy
■ If no other cancer is found, you may start observation or join a clinical trial; an
option for some patients is to have interferon alfa as adjuvant treatment
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NCCN Guidelines
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What are the main treatment options for regional melanoma?
Stage III
■ The main treatment is a wide excision ± sentinel lymph node biopsy
■ If upstaged to stage III by SLN biopsy, may have complete lymph node dissection
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Stage III
in-transit
■ Clinical trial
■ Wide excision
■ Drugs injected into tumor
■ Imiquimod cream
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■ Laser/ablative therapy
■ Palliative radiation therapy
■ Melphalan injected into limb only
■ Systemic therapy
What are the adjuvant treatment options for regional melanoma?
Stage III upstaged
by SLN biopsy
Stage III in-transit
Clinical stage III
■ Clinical trial
■ Observation
■ Clinical trial
■ Observation
■ Clinical trial
■ Observation
■ Interferon alfa
■ Interferon alfa
■ High-dose ipilimumab
■ Interferon alfa (only if free of
disease by surgery)
■ High-dose ipilimumab
■ Biochemotherapy
■ Possible radiation therapy
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What are the options for melanoma that returns near the first tumor?
Cancer returned
near same spot
(local, satellite,
and/or in-trasnit)
■ Clinical trial
■ Wide excision ± SLN biopsy
■ Drugs injected into tumor
■ Imiquimod cream
Cancer came
back in lymph
nodes
■ Complete lymph node dissection if not done before
■ If able to have surgery: tumor excision ± complete lymph node dissection
■ If unable to have surgery or cancer is widespread: systemic therapy
(preferred), clinical trial, palliative radiation therapy, T-VEC injection into
tumor, or best supportive care; then adjuvant treatment
■ Laser/ablative therapy
■ Palliative radiation therapy
■ Melphalan injected into limb only
■ Systemic therapy
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What are the treatment options for metastatic melanoma?
Limited stage IV
■ Surgery, then observation or clinical trial or treat as widespread
■ Observe or systemic therapy, then surgery or treat as widespread
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Widespread
stage IV
■ First, surgery and/or radiation for
cancer spread in brain if needed
■ Systemic therapy
■ Clinical trial
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■ T-VEC injection into tumor
■ Palliative radiation therapy
and/or surgery for symptoms
■ Best supportive care
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Melanoma, Version 1.2016
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