I have a melanoma - now what?

If your doctor diagnoses a melanoma on your skin skin, this is obviously quite a shock and there is lots to think about. Amongst the things the doctor should discuss with you are:  

• Diagnosis
• Stage
• Prognosis
• Risk of recurrence
• Risk of another melanoma - 1%/year Role of sentinel lymph node biopsy
• Role of investigations
• Self examination/detection
• Sun protection

There is absolutely no evidence that for early melanoma (Stage I and II) that any investigations, for example, blood tests, Xrays and/or CAT scans have any role unless there are symptoms. For more advanced melanomas, for example Stage III, some baseline tests may be indicated. These could include full blood count, some biochemistry, Chest XRay and even CAT scans of brain, chest, abdomen and pelvis. Remember that with chest Xrays there is a 10-20% false positive rate which means that a abnormality will be found on the Xray which is benign and innocuous but will still have to be investigated further with concomitant costs and complications of any further investigations.  

Follow-up of patients with melanoma:

• All melanomas < 1mm deep usually are followed up 6 monthly for a couple of years and then yearly after that - remember that there is a risk of another melanoma of roughly 1% a year which is cumulative so that after 20 years the risk is 20% - so 1 in five patients will have another melanoma.

• All melanomas > 1mm deep generally get followed 3-4 monthly for a year, 4-6 monthly for 2-3 years and then 12 monthly lifelong. If these patients have had a SLNB which is negative, probably slightly less frequent follow-up is required