What happens after treatment for melanoma skin cancer?

For many people with melanoma, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer growing or coming back. (When cancer comes back after treatment, it is called recurrent cancer or a recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are leading full lives. Our document, Living With Uncertainty: The Fear of Cancer Recurrence, gives more detailed information on this.

For others, melanoma may never go away completely. These people may get regular treatment with immunotherapy, targeted therapy, chemotherapy, or other treatments to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty.

Follow-up care

If you have completed treatment, your doctors will still want to watch you closely. It is very important to keep all follow-up appointments. Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is a good time for you to ask your health care team any questions you need answered and to discuss any concerns you might have.

Your follow-up should include regular skin and lymph node exams by yourself and by your doctor. How often you need follow-up doctor visits depends on the stage of your melanoma when you were diagnosed and other factors. In addition to the exams, imaging tests may be recommended for some patients.

A typical follow-up schedule for melanomas thinner than 1 mm generally calls for physical exams every 3 to 12 months for several years. If these exams are normal, you can return for a checkup once a year. Your doctor may recommend more frequent exams if you have many moles or atypical moles.

For thicker melanomas or those that had spread beyond the skin, a typical schedule might include physical exams every 3 to 6 months for 2 years, then every 3 to 12 months for the next few years. After that, exams are done at least once a year. Some doctors also recommend imaging tests such as chest x-rays or CT scans every 6 to 12 months for the first several years, especially for people who had more advanced stage disease.

It is also important for melanoma skin cancer survivors to do regular self-exams of their skin and lymph nodes (most doctors recommend at least monthly). You should see your doctor if you find any new lump or change in your skin. You should also report any new symptoms (for example, pain, cough, fatigue, loss of appetite) that do not go away. Melanoma can come back many years after it was first treated.

Patients with stage IV melanoma whose cancer has been completely removed or disappeared after treatment usually have the same follow-up schedule as those with thicker melanomas (see above). Patients with stage IV melanoma that does not go away completely will have a follow-up schedule that is based on their specific situation.

If melanoma does recur, treatment will depend on the location of the cancer, what treatments you've had before, and your overall health. For more information on how recurrent cancer is treated, see the section called “Treatment of melanoma skin cancer by stage.” For more general information on dealing with a recurrence, you might also want to see our document, When Your Cancer Comes Back: Cancer Recurrence. You can get this document by calling 1-800-227-2345.

A person who has had one melanoma may still be at risk for developing another melanoma or a non-melanoma type of skin cancer. People cured of one melanoma should continue to examine their skin every month for new skin cancers, and should avoid too much sun exposure.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself seeing a new doctor who does not know about your medical history. It is important that you be able to give your new doctor the details of your diagnosis and treatment. Make sure you have this information handy:

• A copy of your pathology report(s) from any biopsies or surgeries
• Copies of imaging tests (CT or MRI scans, etc.), which can usually be stored on a CD, DVD, etc.
• If you had surgery, a copy of your operative report(s)
• If you stayed in the hospital, a copy of the discharge summary that doctors prepare when patients are sent home
• If you had radiation therapy, a summary of the type and dose of radiation and when and where it was given
• If you had chemotherapy, targeted therapy, or immunotherapy, a list of your drugs, drug doses, and when you took them
• Contact information for doctors who have treated you and are familiar with your case

It is also important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.