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    Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview for Melanoma

    Table 8. Standard Treatment Options for Melanoma

    Stage (TNM Staging Criteria) Standard Treatment Optionsa
    a Clinical trials are an important option for patients with all stages of melanoma because advances in understanding the aberrant molecular and biologic pathways have led to rapid drug development. Standard treatment options are available in many clinical trials. Information about ongoing clinical trials is available from theNCI Web site.
    Stage 0 melanoma Excision
    Stage I melanoma Excision+/−lymph node management
    Stage II melanoma Excision+/−lymph node management
    Resectable Stage III melanoma Excision+/−lymph node management
    Unresectable Stage III, Stage IV, and Recurrent melanoma Immunotherapy
    Signal transduction inhibitors
    Chemotherapy
    Palliative local therapy

    Excision

    Surgical excision remains the primary modality for treating melanoma. Cutaneous melanomas that have not spread beyond the site at which they developed are highly curable. The treatment for localized melanoma is surgical excision with margins proportional to the microstage of the primary lesion.

    Lymph node management

    Sentinel lymph node biopsy (SLNB)

    Lymphatic mapping and SLNB can be considered to assess the presence of occult metastasis in the regional lymph nodes of patients with primary tumors larger than 1 to 4 mm, potentially identifying individuals who may be spared the morbidity of regional lymph node dissections (LNDs) and individuals who may benefit from adjuvant therapy.[1,2,3,4,5,6]

    To ensure accurate identification of the sentinel lymph node (SLN), lymphatic mapping and removal of the SLN should precede wide excision of the primary melanoma.

    Multiple studies have demonstrated the diagnostic accuracy of SLNB, with false-negative rates of 0% to 2%.[1,6,7,8,9,10,11] If metastatic melanoma is detected, a complete regional lymphadenectomy can be performed in a second procedure.

    Complete lymph node dissection (CLND)

    Patients can be considered for CLND if the sentinel node(s) is microscopically or macroscopically positive for regional control or considered for entry into the Multicenter Selective Lymphadenectomy Trial II (NCT00297895) to determine whether CLND affects survival. SLNB should be performed prior to wide excision of the primary melanoma to ensure accurate lymphatic mapping.

    Adjuvant Therapy

    High-dose interferon alpha-2b was approved by the U.S. Food and Drug Administration (FDA) in 1995 for the adjuvant treatment of patients with melanoma who have undergone a complete surgical resection but who are considered to be at a high risk of relapse (stages IIB, IIC, and III). However, prospective, randomized, multicenter treatment trials have demonstrated that high-dose interferon alpha-2b and pegylated interferon improve relapse-free survival but do not improve overall survival (OS).

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