Melanoma

Follow-up care

After your melanoma treatment has been completed, you must be careful to monitor for recurrence and second cancers. Because of your history of melanoma, you’re at an increased risk for developing a new melanoma or skin cancer, so follow-up care and skin cancer prevention are especially important.

Monitoring for recurrence or a second primary melanoma

Most recurrences of melanoma develop within the first five years after treatment, so your follow-up visits will be more frequent within that time period. However, late recurrence, even after 10 years, is also possible. How often your doctor will see you for follow-up visits depends on several factors, including the stage of the melanoma and your particular risk factors (see Table 1). Your check-ups will include a thorough physical exam with particular attention to your skin and lymph nodes.

Table 1. Recommendations for follow-up after treatment for melanoma

Clinical/pathologic stage Follow-up
Stage 0 (in situ) Annual skin examination.
Stage IA-IIA History and physical examination (with emphasis on lymph nodes and skin) every six to 12 months for five years, then every year as needed; annual chest X-ray. Routine blood work or imaging is not recommended.
Stage IIB-IV History and physical examination (with emphasis on lymph nodes and skin) every three to six months for two years, every three to 12 months for three years, then every year as needed. Imaging studies (chest X-ray, CT, PET/CT and/or MRI) may be done every four to 12 months for people who are at high risk for recurrent or metastatic disease.

 

Tests on blood samples and regular X-rays and imaging scans have not been found to be useful for follow-up, but they may be done if you have symptoms or clinical signs that suggest recurrence. For anyone at a high risk for recurrence, imaging studies may include computed tomography (CT), positron emission tomography (PET) or combined PET/ CT to look for melanoma in the organs and lymph nodes. Magnetic resonance imaging (MRI) may be used to look for the spread of melanoma to the brain, and a bone scan may be performed to look for the spread of melanoma to the bones.

Your doctor will ask you to participate in your follow-up care with a monthly self-examination of your skin for potential melanoma. During these skin checks, you should also look for any abnormal lumps, especially where the surgery was done and in nearby lymph nodes. The “ABCDE” rule will help you know the difference between a melanoma and a benign (not malignant) mole (see Figure 1). Because family history plays an important role in melanoma and other skin cancers, your family members should also have regular skin screenings.

The importance of skin cancer prevention

As the risk of recurrence decreases, the risk of developing a second melanoma or other type of skin cancer increases. This means you must continue skin cancer prevention practices, even when your follow-up visits become further apart. Be prepared to practice skin cancer prevention for your entire life!

The most important preventive measure is to avoid excessive exposure to ultraviolet (UV) rays. The sun is the primary source of UV rays, and you and your family should follow national guidelines to protect yourself (see Helpful Tips below). Protection from UV rays is especially important for people with a fair complexion, light-colored eyes, blond or red hair, and a tendency to burn or freckle with exposure to the sun. Another dangerous source of UV rays is indoor tanning facilities. Studies have shown the risk of melanoma is three times higher for people who regularly use such facilities.

Sun exposure and indoor tanning should never be used for the purpose of increasing your levels of vitamin D. If required, oral supplements are an excellent way to boost your vitamin D levels safely and effectively. To be sure you are getting enough vitamin D, your doctor will likely check your blood levels and may suggest a vitamin D supplement.

 

Hidden dangers – Think before you ink

Monitoring your body for signs of melanoma is a tedious yet necessary task if you want to avoid the most dangerous form of skin cancer. Doctors say this is especially true if you cover your skin with tattoos, as they can delay your diagnosis and put you in more danger than people who are ink-free.

It’s important to watch new and existing moles — along with birthmarks — that change color, shape or size. When ink (or laser tattoo removal) alters the skin’s pigment, these signs are harder to detect, which is why many doctors strongly advise against covering existing skin problems with tattoos.

If you are fair-skinned, have several moles or have relatives with melanoma, think before you ink. If you can’t resist, doctors advise opting for a lighter and smaller tattoo that still allows you to easily survey your skin. Most tattoo artists will steer clear of moles for the very same reason and agree that it’s smart to get clearance from a dermatologist before you decide to decorate any part of your body. 

The same consideration applies when you choose to lose your tattoos with the help of laser treatments. Lasers should never come in contact with moles or birthmarks, so make sure that the procedure can be performed safely before you begin.

Although there’s no connection between tattoos and cancer, there is a realistic concern that they may prevent you from finding and fixing skin problems early, when a cure is more likely.

 

Helpful tips – Protecting yourself from ultraviolet (UV) light exposure

Important protection measures
  • Wear protective clothing. Consider UPF-rated clothes if you sunburn easily.
  • Wear a broad-brimmed hat.
  • Wear sunglasses that protect against UV rays.
  • Minimize your exposure to the sun during its highest intensity (10 a.m. to 4 p.m.).
  • Use lip balm with an SPF of at least 30; petroleum jelly does not provide protection against the sun.
  • Do not use indoor tanning facilities.
Use sunscreen appropriately
  • Choose a sunscreen with a sun protection factor (SPF) of at least 30. For some individuals, a sunscreen with even higher SPF may be necessary to avoid burning.
  • Select a sunscreen that protects against both UVA and UVB rays. Look for labels with the words “broad spectrum” or “multispectrum” or that list ingredients such as titanium dioxide or zinc oxide. (Try to avoid sunscreens with oxybenzone or retinyl palmitate, which may be dangerous for certain groups of people.)
  • Expand the use of sunscreen beyond the summer. Remember that snow reflects up to 80 percent of the sun’s rays.  
  • Use sunscreen anytime you plan to be in the sun for more than 20 minutes, even when it’s cloudy.
  • Apply sunscreen at least 30 minutes before going out in the sun.
  • Use sunscreen even if wearing makeup that contains SPF. (Apply sunscreen underneath makeup.)
  • Apply sunscreen liberally and reapply at least every two hours (sooner if swimming or sweating). Adults need at least a shot glass full of sunscreen lotion per application. If you use a spray sunscreen, be sure to coat all of your exposed skin.
  • Make sure to use sunscreen on often-forgotten areas, such as ears, scalp (if bald) and back of neck.
  • Check the expiration date on the bottle of sunscreen; expired products may not be effective. 

Additional Resources

 

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