Melanoma after treatment in older adults

Overview

Melanoma is a serious type of skin cancer that begins in the cells that give our skin its color, called melanocytes. After treatment for melanoma, the cancer may come back (called recurrence), or a new melanoma may develop on a different part of the skin. This article explains what you need to know after treatment, especially if you are an older adult.

Melanoma is not the most common skin cancer, but it is the most dangerous. After successful treatment, many older adults live for many years. However, having melanoma once does raise your chance of developing another one, so follow-up care is essential.

Melanoma can affect people of any skin color, but it is more common in older adults, especially those with fair skin, a history of sunburns, many moles, or a family history of melanoma. Older adults are at higher risk for new and recurring melanomas, so their skin needs to be checked regularly.

Symptoms

Common symptoms

• A new spot that looks different from other spots on your skin
• A mole that changes in shape, color, or size
• A spot with irregular borders or multiple colors (black, brown, blue, red, or white)
• A spot that itches, bleeds, or does not heal

Symptoms in children

• Melanoma is very rare in children, but the same warning signs apply: new or changing moles, unusual colors, or bleeding spots.
• Children may develop a type of melanoma called spitzoid, which looks like a pink or red bump.

Symptoms in older adults

• In older adults, melanoma often appears as a flat, dark brown or black patch on sun-exposed areas like the face, scalp, ears, neck, or hands.
• It may be mistaken for a harmless age spot, but any spot that is growing, changing, or bleeding should be checked.
• Some older adults may have melanoma in areas that have had little sun exposure, such as the soles of the feet or under the nails.

Causes

Main causes

• Melanoma starts when ultraviolet (UV) light from the sun or tanning beds damages the DNA inside pigment cells. Over time, these damaged cells can grow out of control.
• Previous treatment for melanoma does not cause it to come back, but the same sun exposure and genetic factors that led to the first melanoma are still present.

Risk factors

• Having had melanoma before
• Fair skin, light hair, or blue eyes
• A history of sunburns, especially in childhood
• Many moles or unusual-looking moles
• A family history of melanoma
• A weakened immune system
• Older age

When to see a doctor

See a doctor urgently if:

• If you notice any new or changing mole, a non-healing sore, or any of the emergency symptoms listed above, contact your doctor or go to urgent care the same day.

Book a routine appointment if:

• Attend all scheduled follow-up appointments. Most people need a full skin check every 3 to 12 months, depending on their risk.
• If you have any concerns between appointments, call your care team instead of waiting.

Diagnosis

Your doctor or a skin specialist (dermatologist) will examine your skin carefully, often using a magnifying instrument called a dermoscope. If a spot looks suspicious, they will remove a small piece of it (a biopsy) and send it to a lab to check for cancer cells.

Tests that may be done

• Skin biopsy – removing a small piece of the suspicious area for testing
• Full-body skin examination – checking all areas of your skin, including the scalp, feet, and nails
• Imaging tests (such as CT, MRI, or PET scans) – if the melanoma is thick or your doctor worries it may have spread
• Sentinel lymph node biopsy – removing the first lymph node near the melanoma to check for spread, sometimes done during surgery

What to expect at your appointment

A skin biopsy is usually quick and is done with numbing medicine, so you will feel minimal pain. After the results, your medical team will explain what the findings mean and what steps to take next. You may have a small scar, which is a normal part of the procedure.

Treatment

Treatment for older adults with melanoma depends on how deep the melanoma is, whether it has spread, and your overall health. The goal is to control the cancer while keeping you comfortable and maintaining your quality of life. Your healthcare team will talk through all your options, including how each one works and what side effects you might experience.

Self-care at home

• Use sunscreen with SPF 30 or higher every day, even in winter, and reapply every 2 hours when outside.
• Check your skin once a month in front of a mirror to look at all areas, including your back.
• Wear protective clothing, like wide-brimmed hats and long sleeves, when you are in the sun.
• Keep all your follow-up appointments with your care team.
• Eat a balanced diet and try to stay physically active within your comfort level.

Medical treatments

If melanoma returns or spreads, your doctor may discuss treatments such as further surgery, radiation therapy, immunotherapies (therapies that help your body's immune system fight cancer), targeted therapies (medicines that attack specific changes in melanoma cells), or clinical trials. Your care team will decide which approach is most likely to help you, and they will explain the risks and benefits carefully. No specific medicines are recommended in this article because each person's plan is unique.

When is surgery considered?

Surgery is the most common treatment for early-stage melanoma. The doctor removes the melanoma along with a small margin of normal skin to make sure all the cancer is gone. In many older adults, surgery alone is enough to cure the melanoma. If the melanoma is deeper or has spread, a larger surgery or other treatments may be needed.

Living with this condition

After treatment, you can return to your normal activities with some sun-safe habits. Use sunscreen daily, wear a hat when outside, and examine your skin monthly. Try not to let worry take over your life, but do pay attention to any changes in your skin. It helps to have a family member or friend help you check hard-to-see areas like your back.

Lifestyle tips

• Apply broad-spectrum sunscreen with SPF 30 or higher every day, and use more if you are outdoors.
• Wear a wide-brimmed hat, sunglasses, and long sleeves when the sun is strong.
• Avoid sunlight between 10 a.m. and 4 p.m. when UV rays are strongest.
• Do not use tanning beds or sunlamps.
• If you smoke, talk to your doctor about quitting; smoking can lower your immune system.

Diet and exercise

Eating a healthy diet can help you feel better and keep your strength up. Include plenty of fruits, vegetables, whole grains, and lean proteins. Light exercise, such as walking, swimming, or chair-based activities, is good for your body and mood. Always check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

It is completely normal to feel anxious, sad, or stressed after a diagnosis of melanoma. Many older adults worry that the cancer will come back. These feelings can improve with support. Talk to your healthcare team about how you are feeling, and ask for counseling or support groups if you think they could help.

Prevention

You cannot always prevent a new melanoma, but you can lower your risk significantly. Protecting your skin from UV light, wearing sunscreen, and avoiding tanning beds are the most effective steps. Also, attending regular skin checks and doing self-exams help catch problems early, when treatment is most successful.

Vaccines

There is currently no vaccine to prevent melanoma. However, staying up to date with other recommended vaccines, such as the flu or pneumonia vaccine, can help keep your immune system strong.

Screening programmes

Screening means checking your skin regularly, both by yourself and with your doctor. After a melanoma diagnosis, your doctor will want to see you for full-body skin checks every few months. You should also do your own self-exam every month, looking for any new or changing spots.

Complications

If left untreated

• Melanoma may grow deeper into the skin and spread to lymph nodes, lungs, liver, brain, or bones.
• It may cause open sores, bleeding, or serious infections.
• Spread to vital organs can lead to pain, organ failure, and become life-threatening.

Long-term outlook

If melanoma is found early after treatment, the chances of cure are very high. Even if melanoma comes back or spreads, new treatments have helped many older adults live longer and feel better. Staying on top of follow-up visits and reporting any changes is your best protection. Your healthcare team will be with you, helping you make the best decisions for your health.

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