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MALIGNANT MELANOMA
( By JASCAP )

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After treatment

Follow-up after treatment for melanoma

After the melanoma has been removed your skin cancer specialist will want to see you again. You may only be asked to come back for a couple of visits until your scar has settled down, or you may have regular check-ups every few months for a period of time. This varies with different hospitals and will depend on the advice given by your skin cancer specialist. If you had a melanoma in situ you will usually only be seen once after itís been removed.

Although itís very unlikely that your original melanoma will come back, you are at more risk of developing another primary melanoma (second primary). Because of this you will be shown how to examine your skin and what to look for. Youíll also be given advice on protecting yourself from the sun.

At the clinic
What to look for

At the clinic

Your doctor or specialist nurse will examine your scar and the surrounding area. They will also check the lymph nodes close to the area where the melanoma was removed.

If your melanoma was in the:

Leg - The lymph nodes behind your knees and in your groin will be checked. Chest, back or abdomen - The lymph nodes in your groin, armpits, above the collar bones and in the neck will be checked.
Arm - The lymph nodes in the armpit on the affected side, above your collar bones, and in the lower neck will be checked.
Head or neck area - The lymph nodes in the sides of your neck, under the chin, above the collar bones, behind your ears and at the back of your neck will be checked.

Some people may have photographs taken of their skin and some of their moles measured. This is just a way of comparing and keeping a check on any changes that may develop.

For people whose treatment is over apart from these check-ups, our booklet life after cancer gives useful advice on how to keep healthy and adjust to life after treatment.

What to look for

Your specialist nurse or doctor will give you advice about what to look for and how to examine yourself. Itís important to do this at least once a month because of the risk of getting another primary melanoma and of the small risk of your melanoma coming back. The earlier anything like this is picked up the more chance there is of curing it.

Youíll be asked to check (by looking and feeling):

your scar and the surrounding area the lymph nodes nearby
your skin, from head to toe, for any new or changing moles (using the ABCDE guide).

After a while checking your skin will get easier; youíll become more familiar with your skin and what your moles normally look like. A good time to do this is after a bath or shower. Make sure that you have plenty of light. Use a full length mirror and a small hand held mirror for areas that are hard to reach. You can ask a partner, relative or friend to look at your back and parts of your skin that are hard to see.

After melanoma

Most people with thin melanoma will be cured, and getting back to normal after surgery is usually straightforward. The main change is that from now on youíll have to make sure you protect yourself from the sun. You may also feel anxious or upset for a while but these feelings usually get better as things get back to normal.

Some women have concerns about becoming pregnant, taking the contraceptive pill, or hormone replacement therapy (HRT) after melanoma. Thereís no evidence, however, that getting pregnant, taking the contraceptive pill, or hormone replacement therapy (HRT) increase the risk of melanoma coming back.

Skin care in the sun
How you might feel

Skin care in the sun

After any treatment for malignant melanoma, itís very important to avoid strong sunlight. This reduces the chance of developing a second melanoma.

Protecting yourself from the sun doesnít mean that you can no longer enjoy sunshine or have holidays in sunny countries, but youíll need to take sensible precautions which will in time become part of your normal routine. There are a number of things you can do to protect your skin:

Never allow your skin to burn.
Stay out of the sun or strong sunlight during the hottest part of the day Ė usually between 11am and 3pm.
Wear clothing made of cotton or natural fibres which have a close weave and give more protection against the sun.

Keep your legs and arms covered by wearing long sleeves and trousers. Protect your face and neck with a wide-brimmed hat.

Always wear sunglasses in strong sunlight.
Use a high-factor sunscreen (SPF15 or above) whenever you are exposed to the sun. Follow the instructions on the bottle and re-apply it as recommended, especially after swimming. Choose one that protects against both UVA and UVB radiation (called broad spectrum).
Donít use sunscreen to stay out in the sun for longer, or instead of clothing to protect your skin. The best protection is to cover up and to stay out of strong sunlight.
Never use a sunbed or sunlamp. If itís important for you to look tanned use fake tanning lotions or sprays.

How you might feel

Although your melanoma is likely to be cured you may feel anxious or upset for a while. Talking to family and friends about how you are feeling often helps. You can also talk to your doctor or specialist nurse for advice and support.

Occasionally some people may need more than advice and support from their health professionals and family and friends. Sometimes itís easier to talk to someone whoís not directly involved. Your specialist or GP can usually refer you to a trained counsellor who can help.

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