IF MY MELANOMA HAS BEEN REMOVED, WHY SHOULD I HAVE REGULAR FOLLOW-UPS WITH MY DOCTOR?
People who have had a melanoma are at increased risk of developing brand new melanomas on the skin surface. This risk is highest in the first three years after the original melanoma was diagnosed and thereafter diminishes, but the person will continue to have a higher risk of getting another new primary melanoma for the rest of their lives.
If the primary melanoma has penetrated into the dermis (deep layer) of the skin then it is possible that spread (metastasis) may have occurred. The risk of spread (as previously discussed) is greater in thicker melanomas or where spread to lymph glands has already occurred. Scans may be clear initially but if a microscopic deposit (not possible to detect on available scans) is present in an organ this may continue to grow and cause problems. It is important to detect these metastases as early as possible so that treatment can be initiated quickly.
Routine, regular check-ups give one the best chance of early detection of new melanomas and metastases and thus improve the chances of successful treatment. The frequency of these check-ups is determined by the chance that spread has occurred. Since the chance of a metastasis developing is greatest in the first few years after a melanoma is diagnosed, check-ups should be more frequent (every 3 to 6 months) during this time. As time goes by, however, the risk of a metastasis developing starts to decrease and by 5 years the risk has become low enough for check-ups to be done on an annual basis.
HOW IS MONITORING DONE?
Monitoring is done in three ways:
- examination of a person's body and skin,
- screening with scans and blood tests.
Visits to the doctor only take place as frequently as every three months and the visit only lasts 15 to 30 minutes so it is important, in the interim, to monitor one's own skin and to be alert to any new symptoms (see below). Any new freckle that has suspicious features (click here for more info) needs to be assessed as soon as possible. Any suspicious lump under the skin or in an area of lymph glands also needs to be checked promptly. A good time to feel for glands and lumps under the skin is while taking a bath or shower.
EXAMINATION BY THE DOCTOR
Prior to the actual examination, it is important for the patient to volunteer information about any unusual or persistent symptoms that they may be experiencing. A good rule of thumb is that any new symptom (lethargy, unexplained loss of weight, headache, dizziness, arm or leg weakness, persistent cough, abdominal pain, change in bowel habits etc) that has been present for two or more weeks and is unrelated to any concurrent illness (flu, gastro, bronchitis etc) may be as a result of melanoma spread.
A thorough clinical examination is then performed. Firstly one has a look at the skin to assess whether there are any additional new melanomas on the skin surface. The skin around the primary melanoma biopsy site is felt to make sure that there are no signs of any tumour nodules sitting under the surface of the skin (these are known as satellite lesions).The lymph glands are then palpated (felt) in all areas to feel for any enlargement. Finally, the abdomen is examined to feel for enlargement of the liver and spleen and to exclude any abdominal masses.
Melanoma metastases to internal organs can only be detected at an early stage by doing scans of the body. The type of scan done and the frequency of the scans will be determined by the risk of potential spread. If there is a low risk of spread then a simple x-ray of the lungs once a year will suffice. If someone has had a confirmed spread that has been surgically removed then PET scans are the standard method of screening (click here for more info).
Blood tests are used as a method of screening for melanoma metastases. A liver enzyme, Lactate Dehydrogenase (LD), and a melanoma protein (S100 B) can be measured and their levels compared to the expected normal values of people who have not had a melanoma. If the LD and S100 B values are above the normal range then this may indicate that a metastasis is developing. Unfortunately, these blood tests are not that accurate and in 50% of people who have raised blood markers, no metastasis is ever detected. We therefore only use these blood tests in people who have had a confirmed metastasis either to a lymph gland or an organ. Once the metastasis has been surgically removed and a PET scan shows no evidence of any other metastases, blood tests are done to get baseline values. Blood tests are then repeated every 3 to 6 months and if a significant rise in levels occurs, a PET scan is performed to look for a metastasis.