Melanoma after treatment in adults

Overview

Melanoma is a serious type of skin cancer that starts in the cells that make pigment (color) in your skin. After you have been treated for melanoma, the cancer can sometimes come back. This is called recurrence. This information helps you understand what to look for, how to manage your health after treatment, and when to contact your doctor.

Melanoma is less common than other types of skin cancer, but the number of cases has been rising over the past few decades. After treatment, the chance of it returning depends on many factors, including the stage of the original melanoma and your overall health.

Melanoma can affect adults of any age, but it is more common in older adults. People with fair skin, light hair, or a family history of melanoma are at higher risk. It can also affect people who have had a previous melanoma, so ongoing monitoring is very important.

Symptoms

Common symptoms

• A new, unusual, or changing mole, spot, or growth on your skin
• A mole that changes shape, size, color, or becomes raised
• A mole with irregular, notched, or blurry edges
• A spot that itches, bleeds, or forms a crust
• A dark streak under a nail
• A sore that does not heal
• Swollen or tender lymph nodes (glands) in your neck, armpit, or groin
• Unexplained weight loss, ongoing tiredness, or a persistent cough after treatment

Causes

Main causes

• Melanoma is mostly caused by damage to skin cells from ultraviolet (UV) radiation, which comes from the sun and from tanning beds or sunlamps.
• When UV light hits the skin, it can harm the DNA inside pigment-making cells. Over time, this damage can cause these cells to grow out of control.
• After treatment, melanoma may return because some cancer cells are still present in the body, even if they could not be found during tests.

Risk factors

• Fair skin that burns easily
• Light hair (blonde or red) and light-colored eyes
• A history of sunburns, especially during childhood or frequent sun exposure over many years
• Using indoor tanning beds
• Having many moles or unusual-looking moles
• A family history of melanoma
• Having had melanoma before
• A weakened immune system due to medications or illness

When to see a doctor

See a doctor urgently if:

• If you notice any new or changing mole or skin spot
• If a mole becomes painful, itches, bleeds, or looks unusual
• If you feel a new lump under your skin
• If you have any of the urgent symptoms listed above, such as a persistent cough, unexplained fever, or bone pain

Book a routine appointment if:

• Keep all scheduled follow-up appointments with your dermatologist or cancer specialist, even if you feel well.
• Have a full skin check at least once a year, or more often if your doctor advises it.
• Tell your doctor about any family history of melanoma.

Diagnosis

After treatment, your doctor will examine your skin and may also check your lymph nodes. If you have a new suspicious spot, the doctor will usually do a biopsy, which means taking a small piece of skin to look at under a microscope. Your doctor may also order imaging scans to see if melanoma has spread anywhere else in your body.

Tests that may be done

• Skin examination and dermatoscopy (a special magnifying tool)
• Skin biopsy (removing a small sample of the suspicious area)
• Sentinel lymph node biopsy (checking the first lymph node that drains the area of the cancer)
• Imaging scans such as CT, MRI, or PET scans to look for melanoma in other organs

What to expect at your appointment

A skin biopsy is usually quick and done with local anesthesia. You will get the results after a few days or a week. If you are having scans, they are painless but may involve lying still in a machine. Your doctor will explain what you need to do before each test. After the results, your healthcare team will talk with you about next steps and any treatments you may need.

Treatment

Treatment for melanoma that returns depends on where the cancer is, how much it has spread, and your overall health. You may need more surgery, or you may receive treatments that target cancer cells throughout the body. Your doctor may also recommend clinical trials. Always talk with your healthcare team about the risks and benefits of any treatment.

Self-care at home

• Keep your skin protected from the sun by wearing protective clothing, a wide-brimmed hat, and sunglasses.
• Use a broad-spectrum sunscreen with SPF 30 or higher on any exposed skin, even on cloudy days.
• Do not use tanning beds or sunlamps.
• Stay active and follow a healthy eating plan as recommended by your doctor.
• Keep a record of your skin checks and any changes you notice, and bring this to your appointments.

Medical treatments

Medical treatments for melanoma that has spread may include treatments that boost your body's own immune system to fight the cancer (immunotherapy), medicines that target specific changes in cancer cells (targeted therapy), and in some cases, chemotherapy or radiation therapy. The exact treatment depends on your situation. Your healthcare team will explain the options and what to expect.

When is surgery considered?

If melanoma returns only in one area of the skin or lymph nodes, surgery is often the first treatment. The doctor will remove the melanoma along with a small margin of healthy tissue around it. Surgery is usually done under local or general anesthesia, and most people go home the same day or after a short stay.

Living with this condition

After melanoma treatment, life can feel uncertain. Focus on what you can control: keep your follow-up appointments, check your skin monthly, and stay in touch with your healthcare team. It is normal to feel anxious about a spot that is new or changing. If you notice anything, contact your doctor rather than waiting.

Lifestyle tips

• Limit sun exposure, especially between 10 a.m. and 4 p.m.
• Use sun protection every day, even in winter or when it is cloudy.
• Do not smoke, and limit alcohol to lower your overall cancer risk.
• Try to maintain a healthy weight with regular physical activity and a balanced diet.

Diet and exercise

Eating well and staying active can help you regain strength after treatment. Aim for a diet with plenty of fruits, vegetables, whole grains, and lean protein. Try to get regular exercise, like walking or swimming, starting slowly and building up as you feel able. Ask your doctor what level of activity is safe for you.

Mental health and emotional wellbeing

It is completely normal to feel worried, stressed, or low after melanoma treatment. You may have fears about the cancer coming back. These feelings can be overwhelming. Talk to your doctor or a mental health professional about how you feel. If you are having thoughts of self-harm or are in crisis, contact your local emergency services right away.

Prevention

You cannot completely prevent melanoma from returning, but you can lower your risk by protecting your skin from UV light, checking your skin regularly, and going to all follow-up appointments. The earlier a recurrence is found, the easier it is to treat.

Vaccines

There is currently no vaccine that prevents melanoma. Some vaccines are being studied in clinical trials to treat melanoma, but they are not yet a standard prevention for the general public.

Screening programmes

After melanoma treatment, regular skin checks are a form of screening. Your doctor will tell you how often you need to be checked. You can also practice monthly self-examinations of your skin to look for new or changing spots.

Complications

If left untreated

• Melanoma can grow deeper into the skin and spread to other parts of the body, such as the lymph nodes, lungs, liver, brain, or bones.
• Once it spreads, melanoma can cause serious health problems and can be life-threatening.
• Untreated recurrent melanoma may require more extensive surgery and more intensive treatments.

Long-term outlook

The outlook for people with melanoma has improved greatly in recent years, thanks to new treatments like immunotherapy and targeted therapy. Many people live without the cancer coming back, and even if it does return, treatment can often control it for a long time. Your doctor can give you a clearer idea about your own outlook based on your specific situation.

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