Follow up

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Follow up after a diagnosis of melanoma

April 2023:  Updated in line with the NICE Melanoma Awareness & Management Guidelines (July 2022). If you would like to read more about this topic, please view the lay version of our 2022 position paper on the follow-up of melanoma here. This paper reported prior to the publication of the updated NICE guidelines and therefore the recommendations have been superseded, however, the background information may be of interest. The panel of experts involved in the Melanoma Focus guidelines are aware of some variations and melanoma units are encouraged to review their adherence against the NICE follow-up guidelines.

Stage 1

If you have undergone surgery for a Stage 1 melanoma it is very likely that you will be cured and extremely unlikely that you will have further problems from your melanoma.

nurse and patient at a follow up appointment

However, you will probably be offered follow-up afterwards to ensure that your melanoma has not returned. These visits will include a full skin examination. The recommended length of the follow-up period is likely to depend on what is found when your melanoma is examined under a microscope by the pathologist. Any patient diagnosed with one melanoma is also at slightly higher risk of developing another melanoma or other non-melanoma skin cancers, so your medical team will discuss with you what to look out for.

If you have any questions about the plan for your follow-up, or any concerns during follow-up, you will be able to contact your Melanoma Nurse Specialist. You should let your medical team know if you do not know how to contact your Melanoma Nurse Specialist.

Stage 2

If you have undergone surgery for a Stage 2 melanoma you will be offered follow-up afterwards to ensure your melanoma has not returned. These visits will include a full skin examination. Although most people diagnosed with a Stage 2 melanoma are cured by their surgery, the risk of further problems is higher than for patients diagnosed with Stage 1 melanoma.

Most patients are offered regular surveillance appointments for the first 5 years after diagnosis. These tend to be more frequent in the first 2 years and, all being well, they can be less often in the third, fourth and fifth year. Most patients stop having regular visits after 5 years. There may be specific reasons related to your melanoma or your medical history that mean your medical team agree you should be offered visits more or less frequently. 

You may also be offered surveillance scans, usually with CT or sometimes PET-CT or MRI, to monitor for any early evidence of spread of the melanoma. Scans and other investigations may also be suggested if a concern is identified in between routine surveillance visits. Most CT scans do not find any melanoma and there is a risk that the CT scan will identify something which later turns out to be unrelated and irrelevant but might cause you anxiety. Your medical team will be able to discuss the pros and cons of surveillance imaging with you.

There is NICE guidance which can give you more detailed information on this topic dependent on the exact stage of your melanoma.

There is great interest in whether we can improve the treatment and follow-up of patients with Stage 2 melanoma. You may be offered the opportunity to take part in a clinical trial, in which case your follow-up may be adjusted.

Any patient diagnosed with one melanoma is also at slightly higher risk of developing another melanoma or other non-melanoma skin cancers, so your medical team will discuss with you what to look out for. 

If you have any questions about the plan for your follow-up, or any concerns during follow-up, you will be able to contact your Skin Cancer Nurse Specialist. You should let your medical team know if you do not know how to contact your Melanoma Nurse Specialist.

Stage 3

If you have undergone surgery for a Stage 3 melanoma you will be offered follow-up afterwards to ensure your melanoma has not returned. These visits will include a full skin examination. Although the aim of your surgery has been to cure you, and many patients with Stage 3 melanoma are cured by surgery, there is a risk of further problems and it is important that follow-up is put in place.

Most patients are offered a surveillance appointment every three months, for the first three years after diagnosis and these appointments are usually shared between more than one team. All being well, the frequency of visits usually reduces to every six months in the fourth and fifth year of follow-up and most patients stop having regular visits after five years. There may be specific reasons related to your melanoma or your medical history that mean your medical team agree you should be offered visits more or less frequently. 

It is also likely you will be offered surveillance scans, usually with CT or sometimes with PET-CT or MRI, to monitor for any early evidence of spread of the melanoma. These scans may be offered at regular intervals for several years even if you have no worrying symptoms. Scans and other investigations may also be suggested if a concern is identified in between routine surveillance visits. Most CT scans do not find any melanoma and there is a risk that the CT scan will identify something which later turns out to be unrelated and irrelevant but might cause you anxiety. Your medical team will be able to discuss the pros and cons of surveillance imaging with you.

There is NICE guidance which can give you more detailed information on this topic dependent on the exact stage of your melanoma.

Some patients with Stage 3 melanoma, who were diagnosed after a positive sentinel lymph node test, but have had no other lymph node surgery, may be offered an ultrasound scan of the nearby lymph nodes, to look for any evidence of spread of the melanoma. This may or may not be alongside surveillance CT scans. 

There is great interest in whether we can improve the treatment and follow-up of patients with Stage 3 melanoma. You may be offered the opportunity to take part in a clinical trial, in which case your follow-up may be adjusted.

Any patient diagnosed with one melanoma is also at slightly higher risk of developing another melanoma or other non-melanoma skin cancers, so your medical team will discuss with you what to look out for. 

If you have any questions about the plan for your follow-up, or any concerns during follow-up, you will be able to contact your Melanoma Nurse Specialist. You should let your medical team know if you do not know how to contact your Melanoma Nurse Specialist.

Stage 4

If you have Stage 4 melanoma that has been removed by surgery so that there is no evidence of melanoma on your scan (sometimes called ‘resected Stage 4’), you will be offered follow-up afterwards to watch for signs that your melanoma may have recurred. 

Most patients are offered a surveillance appointment every three months, for the first three years after diagnosis and these appointments may be shared between more than one team. All being well, the frequency of visits usually reduces to every six months in the fourth and fifth year of follow-up. There may be specific reasons related to your melanoma or your medical history that mean your medical team agree you should be offered visits more or less frequently. 

You are very likely to be offered surveillance scans, usually with CT or sometimes with PET-CT or MRI, to monitor for any early evidence of recurrence of the melanoma. These scans may be offered at regular intervals for several years even if you have no worrying symptoms. NICE Guidance (Melanoma: assessment and management (NG14), suggests that patients with Stage 4 melanoma receive CT scans every 3-months for the first 3 years after diagnosis and then every 6-months in the fourth and fifth year.  Scans and other investigations may also be suggested if a concern is identified in between routine surveillance visits.

Many patients with resected Stage 4 melanoma receive a year of treatment after surgery with the aim of reducing the chance that their melanoma will cause further problems. In this case your medical team may offer more frequent clinic visits and may suggest you are scanned more often whilst you are on treatment.

If you have been diagnosed with Stage 4 melanoma that can be seen either on clinical examination or on scans, where surgery is not the best treatment (sometimes called unresectable Stage 4), you will remain under the care of the medical team and will be offered regular follow-up. Follow-up will be tailored to your specific circumstances and is usually very flexible. Follow-up is likely to include a combination of clinic visits, support from your Melanoma Nurse Specialist and regular scans to see what is happening with your melanoma.

In the early months after a diagnosis of Stage 4 melanoma, it is likely you will have contact with your medical team often, at least every three months and more frequently for most patients. If you are on systemic treatment for your melanoma, you may be speaking to your team every few weeks and should know how to contact them in between visits if you have any concerns or feel unwell. If you are on systemic treatment, your medical team will also explain how you can contact the on-call service out-of-hours. 

Many patients on treatment for Stage 4 melanoma are offered a scans every three months, usually with CT or sometimes with PET-CT or MRI. The aim of these scans is to see whether the treatment is helping and to identify if it is time to consider a change of plan. If your melanoma has been stable for some time, your medical team may discuss with you reducing the frequency of your scans. 

There is great interest in whether we can improve the treatment and follow-up of patients with Stage 4 melanoma. You may be offered the opportunity to take part in a clinical trial, in which case your follow-up may be adjusted.

If you have any questions about the plan for your follow-up, or any concerns during follow-up, you will be able to contact your Melanoma Nurse Specialist. You should let your medical team know if you do not know how to contact your Melanoma Nurse Specialist.

 

If you would like to read more about this topic, please view the lay version of our 2022 position paper here.  This position paper reported prior to the publication of NICE Melanoma Awareness & Management Guidelines in July 2022.  The follow-up recommendations made in this position paper have therefore been superseded by the updated NICE guidelines, however, the background information is of interest.  The panel of experts involved in the Melanoma Focus guidelines are aware of some variations and melanoma units are encouraged to review their adherence against the NICE follow-up guidelines.