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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65950_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65950_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65950_"><span class="title" itemprop="name">Melanoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: May 21, 2019.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062713__325">This PDQ cancer information summary has current information about the treatment of melanoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062713__326">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062713__67"><h2 id="_CDR0000062713__67_">General Information About Melanoma</h2><div id="CDR0000062713__67.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062713__68">Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin).</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__309">There are different types of cancer that start in the skin.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__76">Melanoma can occur anywhere on the skin. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__79">Unusual moles, exposure to sunlight, and health history can
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affect the risk of melanoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__83">Signs of melanoma include a change in the way a mole or pigmented area looks. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__88">Tests that examine the skin are used to detect (find) and
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diagnose melanoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__93">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000062713__68"><h3>Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin).</h3><p id="CDR0000062713__70">The skin is the body’s largest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>. It protects against heat, sunlight, injury, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>. Skin also helps control body temperature and stores water, fat, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000427253/" class="def">vitamin D</a>. The skin has several layers, but the two main layers are the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046418/" class="def">epidermis</a> (upper or outer layer) and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046454/" class="def">dermis</a> (lower or inner layer). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445084/" class="def">Skin cancer</a> begins in the epidermis, which is made up of three kinds of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>: </p><ul id="CDR0000062713__308"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046056/" class="def">Squamous cells</a>: Thin, flat cells that form the top layer of the epidermis.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046516/" class="def">Basal cells</a>: Round cells under the squamous cells.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046292/" class="def">Melanocytes</a>: Cells that make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046291/" class="def">melanin</a> and are found in the lower part of the epidermis. Melanin is the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046225/" class="def">pigment</a> that gives skin its natural color. When skin is exposed to the sun or artificial light, melanocytes make more pigment and cause the skin to darken.</div></li></ul><p id="CDR0000062713__315">The number of new cases of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">melanoma</a> has been increasing over the last 30 years. Melanoma is most common in adults, but it is sometimes found in children and
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adolescents. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000062878/#CDR0000062878__132">Unusual Cancers of Childhood Treatment</a> for more information on melanoma in children and adolescents.)</p><div id="CDR0000062713__241" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20skin%2C%20showing%20the%20epidermis%2C%20dermis%2C%20and%20subcutaneous%20tissue&p=BOOKS&id=541550_CDR0000579033.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65950.18/bin/CDR0000579033.jpg" alt="Anatomy of the skin with melanocytes; drawing shows normal skin anatomy, including the epidermis, dermis, hair follicles, sweat glands, hair shafts, veins, arteries, fatty tissue, nerves, lymph vessels, oil glands, and subcutaneous tissue. The pullout shows a close-up of the squamous cell and basal cell layers of the epidermis above the dermis with blood vessels. Melanin is shown in the cells. A melanocyte is shown in the layer of basal cells at the deepest part of the epidermis." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the skin, showing the epidermis, dermis, and subcutaneous tissue. Melanocytes are in the layer of basal cells at the deepest part of the epidermis.</p></div></div></div><div id="CDR0000062713__309"><h3>There are different types of cancer that start in the skin.</h3><p id="CDR0000062713__323">There are two forms of skin cancer: melanoma and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046261/" class="def">nonmelanoma</a>.</p><p id="CDR0000062713__311">Melanoma is a rare form of skin cancer. It is more likely to invade nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046112/" class="def">cutaneous</a> melanoma. Melanoma may also occur in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257212/" class="def">mucous membranes</a> (thin, moist layers of tissue that cover surfaces such as the lips). This PDQ summary is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes.</p><p id="CDR0000062713__313">The most common types of skin cancer are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046515/" class="def">basal cell carcinoma</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046595/" class="def">squamous cell carcinoma</a>. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000258035/">Skin Cancer Treatment</a> for more information on basal cell and squamous cell skin cancer.)</p></div><div id="CDR0000062713__76"><h3>Melanoma can occur anywhere on the skin. </h3><p id="CDR0000062713__78">In men,
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melanoma is often found on the trunk (the area from the shoulders to the hips)
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or the head and neck. In women, melanoma forms most often on the arms and legs.
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</p><p id="CDR0000062713__314">When melanoma occurs in the eye, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269460/" class="def">intraocular</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269467/" class="def">ocular melanoma</a>. (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000258015/">Intraocular (Uveal) Melanoma Treatment</a> for more information.)</p></div><div id="CDR0000062713__79"><h3>Unusual moles, exposure to sunlight, and health history can
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affect the risk of melanoma.</h3><p id="CDR0000062713__81">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. </p><p id="CDR0000062713__322">Risk factors for melanoma include the
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following:</p><ul id="CDR0000062713__261"><li class="half_rhythm"><div>Having a fair complexion, which includes the following:
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<dl id="CDR0000062713__262" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Fair skin that freckles and burns easily, does not tan, or tans poorly.
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</p></dd><dt>-</dt><dd><p class="no_top_margin">Blue or green or other light-colored eyes.
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</p></dd><dt>-</dt><dd><p class="no_top_margin">Red or blond hair.
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</p></dd></dl></div></li><li class="half_rhythm"><div>Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
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</div></li><li class="half_rhythm"><div>Being exposed to certain factors in the environment (in the air, your home or workplace, and your food and water). Some of the environmental risk factors for melanoma are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463162/" class="def">solvents</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046648/" class="def">vinyl chloride</a>, and PCBs. </div></li><li class="half_rhythm"><div>Having a history of many blistering sunburns, especially as a child or teenager.
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</div></li><li class="half_rhythm"><div>Having several large or many small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046286/" class="def">moles</a>.</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a> of unusual moles (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000715624/" class="def">atypical nevus</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndrome</a>).
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</div></li><li class="half_rhythm"><div>Having a family or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of melanoma.
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</div></li><li class="half_rhythm"><div>Being white.
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</div></li><li class="half_rhythm"><div>Having a weakened <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>.</div></li><li class="half_rhythm"><div>Having certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> that are linked to melanoma.</div></li></ul><p id="CDR0000062713__295">Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin. </p><p id="CDR0000062713__304">See the following PDQ summaries for more information on risk factors for melanoma:</p><ul id="CDR0000062713__324"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000552637/">Genetics of Skin Cancer</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062802/">Skin Cancer Prevention</a></div></li></ul></div><div id="CDR0000062713__83"><h3>Signs of melanoma include a change in the way a mole or pigmented area looks. </h3><p id="CDR0000062713__85">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by melanoma or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>.
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Check with your doctor if you have any of the following:</p><ul id="CDR0000062713__86"><li class="half_rhythm"><div>A mole that:
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<dl id="CDR0000062713__87" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">changes in size, shape, or color.</p></dd><dt>-</dt><dd><p class="no_top_margin">has irregular edges or borders.</p></dd><dt>-</dt><dd><p class="no_top_margin">is more than one color.</p></dd><dt>-</dt><dd><p class="no_top_margin">is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269454/" class="def">asymmetrical</a> (if the mole is divided in half, the 2
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halves are different in size or shape).</p></dd><dt>-</dt><dd><p class="no_top_margin">itches.</p></dd><dt>-</dt><dd><p class="no_top_margin"> oozes, bleeds, or is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulcerated</a> (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).</p></dd></dl></div></li><li class="half_rhythm"><div>A change in pigmented (colored) skin.
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</div></li><li class="half_rhythm"><div>Satellite moles (new moles that grow near an existing
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mole).</div></li></ul><p id="CDR0000062713__293">For pictures and descriptions of common moles and melanoma, see <a href="https://www.cancer.gov/types/skin/moles-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Common Moles, Dysplastic Nevi, and Risk of Melanoma</a>.</p></div><div id="CDR0000062713__88"><h3>Tests that examine the skin are used to detect (find) and
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diagnose melanoma.</h3><p id="CDR0000062713__90">If a mole or pigmented area of the skin changes or looks <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>,
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the following tests and procedures can help find and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a>
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melanoma:</p><ul id="CDR0000062713__91"><li class="half_rhythm"><div><b>Skin exam</b>: A doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color,
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size, shape, or texture.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> looks at the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046324/" class="def">lesion</a>. Patients may want to have the sample of tissue checked by a second pathologist. If the abnormal mole or lesion is cancer, the sample of tissue may also be tested for certain gene changes.</div></li></ul><p id="CDR0000062713__92">It is important that abnormal areas of the skin not be shaved off or
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269457/" class="def">cauterized</a> (destroyed with a hot
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instrument, an electric current, or a caustic substance) because cancer cells that remain may grow and spread. </p><p id="CDR0000062713__305">See the PDQ summary on <a href="/books/n/pdqcis/CDR0000258037/">Skin Cancer Screening</a> for more information.</p></div><div id="CDR0000062713__93"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000062713__203">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on
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the following:</p><ul id="CDR0000062713__191"><li class="half_rhythm"><div>The thickness of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and where it is in the body.</div></li><li class="half_rhythm"><div>How quickly the cancer cells are dividing.</div></li><li class="half_rhythm"><div>Whether there was bleeding or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a> of the tumor.
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</div></li><li class="half_rhythm"><div>How much cancer is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</div></li><li class="half_rhythm"><div>The number of places cancer has spread to in the body.</div></li><li class="half_rhythm"><div> The level of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354462/" class="def">lactate dehydrogenase</a> (LDH) in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>.</div></li><li class="half_rhythm"><div>Whether the cancer has certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutations</a> (changes) in a gene called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561325/" class="def">BRAF</a>.</div></li><li class="half_rhythm"><div>The patient’s age and
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general health.</div></li></ul></div></div><div id="CDR0000062713__96"><h2 id="_CDR0000062713__96_">Stages of Melanoma</h2><div id="CDR0000062713__96.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062713__97">After melanoma has been diagnosed, tests are done to find out
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if cancer cells have spread within the skin or to other parts of the body.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__215">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__301">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__264">The stage of melanoma depends on the thickness of the tumor, whether cancer has spread to lymph nodes or other parts of the body, and other factors. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__103">The following stages are used for melanoma:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062713__105">Stage 0 (Melanoma in Situ) </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__108">Stage I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__115">Stage II </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__124">Stage III </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__130">Stage IV </a></div></li></ul></li></ul></div><div id="CDR0000062713__97"><h3>After melanoma has been diagnosed, tests are done to find out
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if cancer cells have spread within the skin or to other parts of the body.
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</h3><p id="CDR0000062713__99">The process used to find out whether <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the skin or to other parts
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of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The
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information gathered from the staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the
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disease. It is important to know the stage in order to plan treatment.
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</p><p id="CDR0000062713__100">The following tests and procedures may be used in the staging
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process:</p><ul id="CDR0000062713__101"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045761/" class="def">Lymph node
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mapping</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046712/" class="def">sentinel lymph node
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biopsy</a></b>: The removal of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045876/" class="def">sentinel lymph node</a> during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. The sentinel lymph node is the first <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> in a group of lymph nodes to receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045760/" class="def">lymphatic drainage</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>. It is the first lymph node the cancer is likely to spread to from the primary tumor. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance and/or blue <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>. The substance or dye flows through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">lymph</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">ducts</a> to the lymph nodes. The first lymph node to receive the substance or dye is removed. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT
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scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A dye may be injected into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">melanoma</a>,
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pictures may be taken of the neck, chest, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron
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emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> tumor cells in the body. A small amount of radioactive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a>. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging) with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597153/" class="def">gadolinium</a></b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues, such as lymph nodes, or organs and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. The picture can be printed to be looked at later.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354462/" class="def">lactate dehydrogenase</a> (LDH). High LDH levels may predict a poor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">response</a> to treatment in patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> disease.</div></li></ul><p id="CDR0000062713__102">The results of these tests are viewed together with the results of
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the tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> to find out the stage of the melanoma.</p></div><div id="CDR0000062713__215"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062713__215_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062713__215_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062713__301"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000062713__301_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000062713__301_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000062713__303">The metastatic tumor is the same type of cancer as the primary tumor. For example, if melanoma spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer cells in the lung are actually melanoma cells. The disease is metastatic melanoma, not lung cancer.</p><div id="CDR0000062713__333" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000062713__264"><h3>The stage of melanoma depends on the thickness of the tumor, whether cancer has spread to lymph nodes or other parts of the body, and other factors. </h3><p id="CDR0000062713__340">To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have. </p><p id="CDR0000062713__341">The stage of melanoma depends on the following:</p><ul id="CDR0000062713__342"><li class="half_rhythm"><div>The thickness of the tumor. The thickness of the tumor is measured from the surface of the skin to the deepest part of the tumor.</div></li><li class="half_rhythm"><div>Whether the tumor is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulcerated</a> (has broken through the skin). </div></li><li class="half_rhythm"><div>Whether cancer is found in lymph nodes by a physical exam, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a>, or a sentinel lymph node biopsy.</div></li><li class="half_rhythm"><div>Whether the lymph nodes are matted (joined together). </div></li><li class="half_rhythm"><div>Whether there are:<ul id="CDR0000062713__343"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634135/" class="def">Satellite tumors</a>: Small groups of tumor cells that have spread within 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> of the primary tumor.</div></li><li class="half_rhythm"><div>Microsatellite tumors: Small groups of tumor cells that have spread to an area right beside or below the primary tumor. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634128/" class="def">In-transit metastases</a>: Tumors that have spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> in the skin more than 2 centimeters away from the primary tumor, but not to the lymph nodes. </div></li></ul></div></li><li class="half_rhythm"><div>Whether the cancer has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, brain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a> (including muscle), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal tract</a>, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first formed. </div></li></ul></div><div id="CDR0000062713__103"><h3>The following stages are used for melanoma:</h3><div id="CDR0000062713__105"><h4>Stage 0 (Melanoma in Situ) </h4><p id="CDR0000062713__107">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352156/" class="def">stage 0</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046292/" class="def">melanocytes</a> are found in the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046418/" class="def">epidermis</a>.
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These abnormal melanocytes may become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and spread into nearby normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>. Stage 0 is also called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000522541/" class="def">melanoma in situ</a>.</p></div><div id="CDR0000062713__108"><h4>Stage I</h4><p id="CDR0000062713__110"> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045136/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed. Stage I is divided into stages IA and IB.</p><div id="CDR0000062713__344" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Millimeters%20(mm)&p=BOOKS&id=541550_CDR0000578121.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65950.18/bin/CDR0000578121.jpg" alt="Millimeters; drawing shows millimeters (mm) using everyday objects. A sharp pencil point shows 1 mm, a new crayon point shows 2 mm, and a new pencil-top eraser shows 5 mm." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.</p></div></div><ul id="CDR0000062713__111"><li class="half_rhythm"><div>Stage IA: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is not more than 1
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeter</a> thick, with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>.</div></li><li class="half_rhythm"><div>Stage IB: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is more than 1 but not more than 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> thick, without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>. </div></li></ul></div><div id="CDR0000062713__115"><h4>Stage II </h4><p id="CDR0000062713__117"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045137/" class="def">Stage II</a> is divided
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into stages IIA, IIB, and IIC.</p><ul id="CDR0000062713__118"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045137/" class="def">Stage IIA</a>: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is either:
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<dl id="CDR0000062713__120" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">more than 1 but not more than 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> thick, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>;
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or</p></dd><dt>-</dt><dd><p class="no_top_margin">more than 2 but not more than 4 millimeters thick, without ulceration. </p></dd></dl>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045137/" class="def">Stage IIB</a>: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is either:
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<dl id="CDR0000062713__122" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">more than 2 but not more than 4 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> thick, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>;
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or</p></dd><dt>-</dt><dd><p class="no_top_margin">more than 4 millimeters thick, without
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ulceration.</p></dd></dl>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045137/" class="def">Stage IIC</a>: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is more than 4 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a>
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thick, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>.
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</div></li></ul></div><div id="CDR0000062713__124"><h4>Stage III </h4><p id="CDR0000062713__345">Stage III is divided into stages IIIA, IIIB, IIIC, and IIID.</p><ul id="CDR0000062713__346"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045138/" class="def">Stage IIIA</a>: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is not more than 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeter</a> thick, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>, or not more than 2 millimeters thick, without ulceration. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found in 1 to 3 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046712/" class="def">sentinel lymph node biopsy</a>.</div></li><li class="half_rhythm"><div>Stage IIIB:<ul id="CDR0000062713__347" class="simple-list"><li class="half_rhythm"><div>(1) It is not known where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> began or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a> can no longer be seen, and one of the following is true:<ul id="CDR0000062713__348"><li class="half_rhythm"><div class="half_rhythm">cancer is found in 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a>; or</div></li><li class="half_rhythm"><div class="half_rhythm">there are microsatellite tumors, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634135/" class="def">satellite tumors</a>, and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634128/" class="def">in-transit metastases</a> on or under the skin.</div><div class="half_rhythm"><i><b>or</b></i></div></li></ul></div></li></ul><ul id="CDR0000062713__361" class="simple-list"><li class="half_rhythm"><div>(2) The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is not more than 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeter</a> thick, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>, or not more than 2 millimeters thick, without ulceration, and one of the following is true:<ul id="CDR0000062713__349"><li class="half_rhythm"><div class="half_rhythm">cancer is found in 1 to 3 lymph nodes by physical exam or imaging tests; or </div></li><li class="half_rhythm"><div class="half_rhythm">there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.</div><div class="half_rhythm"><b><i>or</i></b></div></li></ul></div></li></ul><ul id="CDR0000062713__362" class="simple-list"><li class="half_rhythm"><div>(3) The tumor is more than 1 but not more than 2 millimeters thick, with ulceration, or more than 2 but not more than 4 millimeters thick, without ulceration, and one of the following is true: <ul id="CDR0000062713__350"><li class="half_rhythm"><div>cancer is found in 1 to 3 lymph nodes; or </div></li><li class="half_rhythm"><div>there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. </div></li></ul></div></li></ul></div></li><li class="half_rhythm"><div>Stage IIIC: <ul id="CDR0000062713__356" class="simple-list"><li class="half_rhythm"><div>(1) It is not known where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> began, or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a> can no longer be seen. Cancer is found:<ul id="CDR0000062713__351"><li class="half_rhythm"><div class="half_rhythm">in 2 or 3 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or </div></li><li class="half_rhythm"><div class="half_rhythm">in 1 lymph node and there are microsatellite tumors, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634135/" class="def">satellite tumors</a>, and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634128/" class="def">in-transit metastases</a> on or under the skin; or </div></li><li class="half_rhythm"><div class="half_rhythm">in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or </div></li><li class="half_rhythm"><div class="half_rhythm">in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. </div><div class="half_rhythm"><b><i>or</i></b></div></li></ul></div></li></ul><ul id="CDR0000062713__363" class="simple-list"><li class="half_rhythm"><div>(2) The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is not more than 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> thick, with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>, or not more than 4 millimeters thick, without ulceration. Cancer is found:<ul id="CDR0000062713__352"><li class="half_rhythm"><div class="half_rhythm">in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or </div></li><li class="half_rhythm"><div class="half_rhythm">in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or </div></li><li class="half_rhythm"><div class="half_rhythm">in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. </div><div class="half_rhythm"><b><i>or</i></b></div></li></ul></div></li></ul><ul id="CDR0000062713__364" class="simple-list"><li class="half_rhythm"><div class="half_rhythm">(3) The tumor is more than 2 but not more than 4 millimeters thick, with ulceration, or more than 4 millimeters thick, without ulceration. Cancer is found in 1 or more lymph nodes and/or in any number of lymph nodes that are matted together. There may be microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.</div><div class="half_rhythm"><b><i>or</i></b></div></li></ul>
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<ul id="CDR0000062713__365" class="simple-list"><li class="half_rhythm"><div>(4) The tumor is more than 4 millimeters thick, with ulceration. Cancer is found in 1 or more lymph nodes and/or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.</div></li></ul></div></li><li class="half_rhythm"><div>Stage IIID: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is more than 4 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> thick, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulceration</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found: <ul id="CDR0000062713__353"><li class="half_rhythm"><div>in 4 or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or in any number of lymph nodes that are matted together; or </div></li><li class="half_rhythm"><div>in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634135/" class="def">satellite tumors</a>, and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000634128/" class="def">in-transit metastases</a> on or under the skin.</div></li></ul></div></li></ul></div><div id="CDR0000062713__130"><h4>Stage IV </h4><p id="CDR0000062713__132">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045139/" class="def">stage IV</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, brain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>, bone, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a> (including muscle), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal (GI) tract</a>, and/or distant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer may have spread to places in the skin far away from where it first started.</p></div></div></div><div id="CDR0000062713__133"><h2 id="_CDR0000062713__133_">Recurrent Melanoma</h2><p id="CDR0000062713__134"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">melanoma</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has recurred
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(come back) after it has been treated. The cancer may come back in the area where it first started or in other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</p></div><div id="CDR0000062713__135"><h2 id="_CDR0000062713__135_">Treatment Option Overview</h2><div id="CDR0000062713__135.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062713__136">There are different types of treatment for patients with
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melanoma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__140">Five types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062713__142">Surgery </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__148">Chemotherapy </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__152">Radiation therapy
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__155">Immunotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__280">Targeted therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062713__158">New types of treatment are being tested in clinical trials.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__334">Treatment for melanoma may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__217">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__219">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062713__221">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000062713__136"><h3>There are different types of treatment for patients with
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melanoma. </h3><p id="CDR0000062713__138">Different types of treatment are available for patients with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">melanoma</a>. Some treatments are
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some are being tested in
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A
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treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current
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treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.
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When clinical trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000062713__140"><h3>Five types of standard treatment are used:</h3><div id="CDR0000062713__142"><h4>Surgery </h4><p id="CDR0000062713__144">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000589417/" class="def">primary treatment</a> of
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all <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stages</a> of melanoma. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446983/" class="def">wide local excision</a> is used to remove the melanoma and some of the normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> around it. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046581/" class="def">Skin grafting</a> (taking skin from another part of the body to replace the skin that is removed) may be done to cover the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000441269/" class="def">wound</a> caused by surgery. </p><p id="CDR0000062713__316">It is important to know whether cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045761/" class="def">Lymph node mapping</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046712/" class="def">sentinel lymph node biopsy</a> are done to check for cancer in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045876/" class="def">sentinel lymph node</a> (the first lymph node in a group of lymph nodes to receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045760/" class="def">lymphatic drainage</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>). It is the first lymph node the cancer is likely to spread to from the primary tumor. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance and/or blue <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> near the tumor. The substance or dye flows through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">lymph</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">ducts</a> to the lymph nodes. The first lymph node to receive the substance or dye is removed. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. If cancer cells are found, more lymph nodes will be removed and tissue samples will be checked for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of cancer. This is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045763/" class="def">lymphadenectomy</a>. Sometimes, a sentinel lymph node is found in more than one group of nodes.</p><p id="CDR0000062713__147">After the doctor removes all the melanoma that can be seen at
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the time of the surgery, some patients may be given <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> after surgery to kill
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any cancer cells that are left. Chemotherapy given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</p><p id="CDR0000062713__317">Surgery to remove cancer that has spread to the lymph nodes, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal (GI) tract</a>, bone, or brain may be done to improve the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> by controlling <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>.</p></div><div id="CDR0000062713__148"><h4>Chemotherapy </h4><p id="CDR0000062713__150">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>).</p><p id="CDR0000062713__296">One type of regional chemotherapy is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045716/" class="def">hyperthermic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044853/" class="def">isolated limb perfusion</a>. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> to and from the limb is temporarily stopped with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000613900/" class="def">tourniquet</a>. A warm solution with the anticancer drug is put directly into the blood of the limb. This gives a high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of drugs to the area where the cancer is.</p><p id="CDR0000062713__204">The way the chemotherapy is given depends on the type and stage of the cancer being treated.</p><p id="CDR0000062713__277">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/melanoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Melanoma</a> for more information.</p></div><div id="CDR0000062713__152"><h4>Radiation therapy
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</h4><p id="CDR0000062713__154"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy: </p><ul id="CDR0000062713__332"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a radioactive substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000062713__318">The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat melanoma, and may also be used as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve symptoms and improve quality of life.</p></div><div id="CDR0000062713__155"><h4>Immunotherapy</h4><p id="CDR0000062713__157"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy. </p><p id="CDR0000062713__327">The following types of immunotherapy are being used in the treatment of melanoma:</p><ul id="CDR0000062713__319"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>: Some types of immune cells, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a>, and some cancer cells have certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, called checkpoint proteins, on their surface that keep <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced</a> melanoma or tumors that cannot be removed by surgery.</div><div class="half_rhythm">There are two types of immune checkpoint inhibitor therapy:<ul id="CDR0000062713__328"><li class="half_rhythm"><div>CTLA-4 inhibitor: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">Ipilimumab</a> is a type of CTLA-4 inhibitor.<div id="CDR0000062713__374" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=541550_CDR0000776560.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65950.18/bin/CDR0000776560.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of the T-cell receptor (TCR) to antigen and MHC proteins on the antigen-presenting cell (APC) and the binding of CD28 on the T cell to B7-1/B7-2 on the APC. It also shows the binding of B7-1/B7-2 to CTLA-4 on the T cell, which keeps the T cells in the inactive state. The panel on the right shows immune checkpoint inhibitor (anti-CTLA antibody) blocking the binding of B7-1/B7-2 to CTLA-4, which allows the T cells to be active and to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as B7-1/B7-2 on antigen-presenting cells (APC) and CTLA-4 on T cells, help keep the body’s immune responses in check. When the T-cell receptor (TCR) binds to antigen and major histocompatibility complex (MHC) proteins on the APC and CD28 binds to B7-1/B7-2 on the APC, the T cell can be activated. However, the binding of B7-1/B7-2 to CTLA-4 keeps the T cells in the inactive state so they are not able to kill tumor cells in the body (left panel). Blocking the binding of B7-1/B7-2 to CTLA-4 with an immune checkpoint inhibitor (anti-CTLA-4 antibody) allows the T cells to be active and to kill tumor cells (right panel).</p></div></div></div></li><li class="half_rhythm"><div>PD-1 inhibitor: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">Pembrolizumab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a> are types of PD-1 inhibitors.</div></li></ul></div></li></ul><div id="CDR0000062713__331" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=541550_CDR0000774646.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65950.18/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div><div id="CDR0000062713__369" class="box"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div><ul id="CDR0000062713__370"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045324/" class="def">Interferon</a>: Interferon affects the division of cancer cells and can slow tumor growth.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045256/" class="def">Interleukin-2</a> (IL-2): IL-2 boosts the growth and activity of many immune cells, especially <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocytes</a> (a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cell</a>). Lymphocytes can attack and kill cancer cells.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045290/" class="def">Tumor necrosis factor</a> (TNF) therapy: TNF is a protein made by white blood cells in response to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigen</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>. TNF is made in the laboratory and used as a treatment to kill cancer cells. It is being studied in the treatment of melanoma.</div></li></ul><p id="CDR0000062713__278">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/melanoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Melanoma</a> for more information.</p></div><div id="CDR0000062713__280"><h4>Targeted therapy</h4><p id="CDR0000062713__282"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following types of targeted therapy are used or being studied in the treatment of melanoma:
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</p><ul id="CDR0000062713__275"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044829/" class="def">Signal transduction inhibitor</a> therapy: Signal transduction inhibitors block <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561720/" class="def">signals</a> that are passed from one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045065/" class="def">molecule</a> to another inside a cell. Blocking these signals may kill cancer cells. They are used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery. Signal transduction inhibitors include:
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<ul id="CDR0000062713__373"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750801/" class="def">BRAF inhibitors</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750069/" class="def">dabrafenib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000702051/" class="def">vemurafenib</a>, encorafenib) that block the activity of proteins made by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutant</a> BRAF <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>; and</div></li><li class="half_rhythm"><div>MEK inhibitors (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750072/" class="def">trametinib</a>, cobimetinib, binimetinib) that block proteins called MEK1 and MEK2 which affect the growth and survival of cancer cells.</div></li></ul></div><div class="half_rhythm">Combinations of BRAF inhibitors and MEK inhibitors used to treat melanoma include:
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<ul id="CDR0000062713__371"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750069/" class="def">Dabrafenib</a> plus <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750072/" class="def">trametinib</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000702051/" class="def">Vemurafenib</a> plus cobimetinib.</div></li><li class="half_rhythm"><div>Encorafenib plus binimetinib.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615576/" class="def">Oncolytic virus therapy</a>: A type of targeted therapy that is used in the treatment of melanoma. Oncolytic virus therapy uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">virus</a> that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells.
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Talimogene laherparepvec is a type of oncolytic virus therapy made with a form of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046366/" class="def">herpesvirus</a> that has been changed in the laboratory. It is injected directly into tumors in the skin and lymph nodes.</div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">Angiogenesis inhibitors</a>: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.
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</div></li></ul><p id="CDR0000062713__306">New targeted therapies and combinations of therapies are being studied in the treatment of melanoma.</p><p id="CDR0000062713__287">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/melanoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Melanoma</a> for more information.</p></div></div><div id="CDR0000062713__158"><h3>New types of treatment are being tested in clinical trials.
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</h3><p id="CDR0000062713__214">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000062713__339"><h4>Vaccine therapy</h4><p id="CDR0000062713__338"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">Vaccine therapy</a> is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045138/" class="def">stage III melanoma</a> that can be removed by surgery.</p></div></div><div id="CDR0000062713__334"><h3>Treatment for melanoma may cause side effects.</h3><p id="CDR0000062713__334_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000062713__217"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062713__217_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000062713__217_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000062713__217_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000062713__219"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000062713__219_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000062713__219_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000062713__221"><h3>Follow-up tests may be needed.</h3><p id="CDR0000062713__221_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000062713__221_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000062713__165"><h2 id="_CDR0000062713__165_">Treatment Options by Stage </h2><p id="CDR0000062713__336">For information about the treatments listed below, see the <a href="#CDR0000062713__140">Treatment Option Overview</a> section.</p><div id="CDR0000062713__166"><h3>Stage 0 (Melanoma in Situ)</h3><p id="CDR0000062713__167">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352156/" class="def">stage 0</a> is usually <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the area of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> and a small amount of normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> around it.</p><p id="CDR0000062713__TrialSearch_166_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062713__168"><h3>Stage I Melanoma</h3><p id="CDR0000062713__169">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045136/" class="def">stage I
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melanoma</a> may include the following: </p><ul id="CDR0000062713__170"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and some of the normal
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> around it. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045761/" class="def">lymph node mapping</a> and removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> is also done. </div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of new ways to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in
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the lymph nodes.</div></li></ul><p id="CDR0000062713__TrialSearch_168_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062713__172"><h3>Stage II Melanoma</h3><p id="CDR0000062713__173">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045137/" class="def">stage II melanoma</a> may include the following:</p><ul id="CDR0000062713__174"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and some of the normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>
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around it. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045761/" class="def">lymph node mapping</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046712/" class="def">sentinel
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lymph node biopsy</a> are done to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> at the same time as the surgery to remove the tumor. If cancer is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045876/" class="def">sentinel lymph node</a>, more lymph nodes may be removed.</div></li><li class="half_rhythm"><div>Surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045324/" class="def">interferon</a> if there is a high risk that the cancer will come back.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of new types of treatment to be used after surgery.</div></li></ul><p id="CDR0000062713__TrialSearch_172_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062713__176"><h3>Stage III Melanoma That Can Be Removed By Surgery</h3><p id="CDR0000062713__177">Treatment of stage III melanoma that can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> may include the following:</p><ul id="CDR0000062713__269"><li class="half_rhythm"><div>Surgery to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and some of the normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> around it. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046581/" class="def">Skin grafting</a> may be done to cover the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000441269/" class="def">wound</a> caused by
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surgery. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045761/" class="def">lymph node mapping</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046712/" class="def">sentinel
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lymph node biopsy</a> are done to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> at the same time as the surgery to remove the tumor. If cancer is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045876/" class="def">sentinel lymph node</a>, more lymph nodes may be removed.</div></li><li class="half_rhythm"><div>Surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">ipilimumab</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045324/" class="def">interferon</a> if there is a high risk that the cancer will come back.</div></li><li class="half_rhythm"><div>Surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750069/" class="def">dabrafenib</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750072/" class="def">trametinib</a> if there is a high risk that the cancer will come back.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of immunotherapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">vaccine therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapies</a> that target specific <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes.</div></li></ul><p id="CDR0000062713__TrialSearch_176_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062713__180"><h3>Stage III Melanoma That Cannot Be Removed By Surgery, Stage IV Melanoma, and Recurrent Melanoma</h3><p id="CDR0000062713__181">Treatment of stage III melanoma that cannot be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045139/" class="def">stage IV melanoma</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">melanoma</a> may include the following:</p><ul id="CDR0000062713__286"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615576/" class="def">Oncolytic virus therapy</a> (talimogene laherparepvec) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">ipilimumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">pembrolizumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045256/" class="def">interleukin-2</a> (IL-2). Sometimes ipilimumab and nivolumab are given together.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044829/" class="def">signal transduction inhibitors</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750069/" class="def">dabrafenib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750072/" class="def">trametinib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000702051/" class="def">vemurafenib</a>, cobimetinib, encorafenib, binimetinib). These may be given alone or in combination.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">Palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>. This may include:<dl id="CDR0000062713__297" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Surgery to remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or tumors in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal (GI) tract</a>, bone, or brain.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to the brain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>, or bone.</p></dd></dl>
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</div></li></ul><p id="CDR0000062713__298">Treatments that are being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following: </p><ul id="CDR0000062713__299"><li class="half_rhythm"><div>Immunotherapy alone or in combination with other therapies such as targeted therapy.</div></li><li class="half_rhythm"><div>For melanoma that has spread to the brain, immunotherapy with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a> plus <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">ipilimumab</a>.</div></li><li class="half_rhythm"><div>Targeted therapy, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044829/" class="def">signal transduction inhibitors</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">angiogenesis inhibitors</a>, oncolytic virus therapy, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> that target certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutations</a>. These may be given alone or in combination.</div></li><li class="half_rhythm"><div>Surgery to remove all known <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">Regional chemotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045716/" class="def">hyperthermic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044853/" class="def">isolated limb perfusion</a>). Some patients may also have immunotherapy with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045290/" class="def">tumor necrosis factor</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">Systemic chemotherapy</a>.</div></li></ul><p id="CDR0000062713__TrialSearch_180_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062713__209"><h2 id="_CDR0000062713__209_">To Learn More About Melanoma</h2><p id="CDR0000062713__210">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about melanoma, see the following:</p><ul id="CDR0000062713__279"><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/skin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Skin Cancer (Including Melanoma) Home Page</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062802/">Skin Cancer Prevention</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258037/">Skin Cancer Screening</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Sentinel Lymph Node Biopsy</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/melanoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Melanoma</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/bio-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Biological Therapies for Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li><li class="half_rhythm"><div><a href="https://analysistools.nci.nih.gov/nevustool/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Moles to Melanoma: Recognizing the ABCDE Features</a></div></li></ul><p id="CDR0000062713__209_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000062713__209_41"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000062713__AboutThis_1"><h2 id="_CDR0000062713__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062713__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062713__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062713__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062713__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062713__AboutThis_6">This PDQ cancer information summary has current information about the treatment of melanoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062713__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062713__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000062713__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062713__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062713__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062713__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062713__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062713__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062713__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062713__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Melanoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389388]</p><p id="CDR0000062713__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000062713__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062713__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062713__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062713__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65950</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389388" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389388</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65950.18/?report=reader">PubReader</a></li><li><a href="/books/NBK65950.18/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65950" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65950" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Melanoma Treatment (PDQ®): Patient Version. 2019 May 21. 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Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65950.30/">NBK65950.30</a></span> November 1, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65950.29/">NBK65950.29</a></span> June 30, 2023</li><li><span class="bk_col_itm"><a 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remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062713__67" ref="log$=inpage&link_id=inpage">General Information About Melanoma</a></li><li><a href="#CDR0000062713__96" ref="log$=inpage&link_id=inpage">Stages of Melanoma</a></li><li><a href="#CDR0000062713__133" ref="log$=inpage&link_id=inpage">Recurrent Melanoma</a></li><li><a href="#CDR0000062713__135" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062713__165" ref="log$=inpage&link_id=inpage">Treatment Options by Stage </a></li><li><a href="#CDR0000062713__209" ref="log$=inpage&link_id=inpage">To Learn More About Melanoma</a></li><li><a href="#CDR0000062713__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66034/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909947" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389277" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Intraocular (Uveal) Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Intraocular (Uveal) Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a 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2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389197" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909939" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Chordoma (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Chordoma (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ 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<a class="text-white" href="https://www.hhs.gov/">HHS</a>
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