Melanoma

Follow-up care

Stay Alert For Signs and Symptoms After Primary Treatment

Completing your primary melanoma treatment is a welcome milestone, but recurrence can sometimes happen. It is also important to know that being diagnosed with melanoma increases your risk of developing a new melanoma or skin cancer. That’s why follow-up care and skin cancer prevention are vital. Knowing your risks and what to watch for are key to early detection and a potentially better prognosis.

Early-stage (thin) melanomas generally tend to recur less often but over a longer period of time. Later-stage melanomas, on the other hand, recur more often and over a shorter time period. For all stages, the risk of recurrence generally decreases over time, though it is never gone completely.

Following are ways to watch for recurrence or another melanoma.

Self-exams involve you and a loved one checking yourself for any moles or spots that change shape, size or color. The “ABCDE” rule will help you identify the common differences between a melanoma and a mole that is harmless (benign).

During self-exams, also look for any abnormal lumps. Pay special attention to the area where you had surgery (if applicable), as well as nearby lymph nodes.

Melanoma and other skin cancers may run in families, so encourage your family members to have regular skin screenings and learn how to protect their skin.

Office visits will be based on a follow-up schedule customized for you. Your doctor will consider your diagnosis, stage, type of treatment you received and your risk factors, such as:

  • A fair complexion
  • Light-colored eyes
  • Blonde or red hair
  • A history of blistering sunburns
  • A tendency to burn or freckle
  • Large moles or many small moles
  • A family history of melanoma

During these check-ups, your doctor will conduct a thorough physical exam, paying special attention to your skin. Melanoma can spread to lymph nodes, so your doctor will check those closely, too. Blood tests, regular X-rays and other imaging studies are not usually done for earlier-stage melanoma follow-up, but they may help if you have signs or symptoms of a possible recurrence.

If you are at a higher risk of having your melanoma return, your doctor may order one or more of these imaging studies to check for melanoma in your body:

  • Chest X-ray
  • Computed tomography (CT)
  • Positron emission tomography (PET)
  • Combined PET/CT
  • Magnetic resonance imaging (MRI)

Prevention: A Habit For Everyone

Even though your follow-up visits will get further apart in the future, skin cancer prevention should become something you do for the rest of your life, regardless of the color of your skin. Though darker skin contains more melanin, the pigment that gives color to the skin, every skin tone is vulnerable. The biggest risk factor: ultraviolet (UV) light, mostly from the sun. Indoor tanning is another dangerous source of UV rays, particularly for younger people.

Here are five ways to protect your skin:

  1. Wear protective clothing. If you sunburn easily, consider clothes with a rated ultraviolet protection factor (UPF).
  2. Limit sun exposure from 10 a.m. to 4 p.m.
  3. Wear a broad-brimmed hat and sunglasses that protect against UV rays.
  4. Choose a sunscreen and a lip balm with an SPF of at least 15 to 30 that protects against both UVA and UVB rays. Labels on sunscreen may say “broad spectrum” or “multi-spectrum” and may include ingredients such as titanium dioxide or zinc oxide.
  5. Apply sunscreen liberally on all exposed skin, and reapply at least every two hours (sooner if swimming or sweating). Don’t forget ears, the back of your neck and exposed parts of your scalp.

Post-Melanoma Treatment Follow-Up Recommendations

Stage Recommendation
Stage 0 (in situ)
  • Annual skin examination for life.
  • History and physical exam (with a focus on skin and lymph nodes) every 6 to 12 months for 5 years and then every year, as needed.
Stage IA-IIA
  • Imaging only to follow up on certain signs or symptoms.
  • History and physical exam (with a focus on skin and lymph nodes) every 3 to 6 months for 2 years, every 3 to 12 months for 2 years, and then every year as needed.
Stage IIB-IV
  • Imaging may be done every 3 to 12 months for 2 years and every 6 to 12 months for 3 years to screen for recurrence or spread of cancer.
  • History and physical exam to be done every 3 to 6 months for 2 years, and then every 3 to 12 months for 3 years and then annually as clinically indicated.

 

Watching For and Lowering Your Risk of Recurrence

Even after successful treatment, melanoma may return — possibly years later. You may worry this could happen to you. However, learning how to watch for and lower your risk of recurrence may ease your mind.

Types of recurrence. Melanoma can return in one or more ways:

  • Local recurrence is a regrowth of the cancer at a site of the original melanoma.
  • Regional recurrence is reappearance of cancer in the lymph nodes near the melanoma.
  • Distant recurrence is metastasis (spread) of the melanoma to distant organs. You may have symptoms or your doctor will see signs of a tumor on a CT or PET.

Keeping follow-up appointments is important because finding signs of a recurrence early is crucial to successful treatment. Your doctor will ask questions about any ongoing symptoms you may have, especially those related to recurrence, and long-term side effects of treatment.

 

 

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.

 

 

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