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Adjuvant radiation for malignant melanoma
Alberta Provincial Cutaneous Tumour Team.
Cancer Care; 2012 Mar. 7 p. (Clinical practice guideline; no. CU-003
Most patients with in-situ or early-stage melanoma (Stage 0; Stage 1A/B; Stage II, 1 mm thick with ulceration or Clark level IV, V or >1 mm thick, any characteristic; and Stage III, sentinel node positive):
- There is no recommendation for the use of adjuvant radiation therapy, as most of these patients will be cured by primary excision alone (National Comprehensive Cancer Network [NCCN], 2009).
- Post-operative radiotherapy may be used after close or positive margins where further excision is not practical or possible, inoperative lentigo maligna, rapid or multiple recurrences or extensive perineural spread (as seen with Desmoplastic melanoma).
Patients with Stage IIIC or Stage IV disease should be referred for the consideration of adjuvant radiation therapy to improve local and regional control of their disease (NCCN, 2009)
- Stage IIIC with multiple nodes involved or extranodal extension: consider radiation therapy to nodal basin.
- Stage III in transit: consider radiation therapy.
- Stage IV metastatic: if disseminated (unresectable) with brain metastases, consider radiation for symptomatic patients.
Consider the following for patients with recurrence (NCCN, 2009):
- Recurrence (true local scar): base treatment on stage of recurrence.
- Recurrence (local, satellitosis, and/or in-transit): consider radiation therapy.
- Recurrence (nodal): consider adjuvant radiation therapy.
- Recurrence (distant): if disseminated (unresectable) with brain metastases, consider radiation for symptomatic patients.
If interferon is to be part of the treatment regimen:
- Radiation should not be given concurrently.
- Interferon may act as a radiosensitizer, and patients receiving both may experience increased toxicities.
- Radiation therapy may be delayed until completion of the induction phase of interferon administration.