Follow-up

Patients are followed up depending on what type of skin cancer they have, and how extensive the tumour has been

Basal Cell Carcinoma

Once a basal cell carcinoma has been completely removed, patients can usually be discharged with advice about sun safety, and what to look out for in the future. Sometimes, if the margin of safety has been reported to your doctor as being narrow, they will discuss with you about either taking some more skin away, or following you for a longer period of time to monitor the area for signs of the tumour coming back.

Squamous Cell Carcinoma

Your doctor will tell you what type of squamous cell carcinoma you have had removed. Patients who have had a ‘well differentiated’ SCC only need to be followed up for a short period of time as there is a low risk of these returning if they have been removed with a suitable margin of safety.

If it is ‘moderately’ or ‘poorly differentiated’, you will be followed for a few years. At each visit your doctor will check the area of your body where the tumour was removed from, as well as examining the nearest lymph glands to check for any sign of tumour cells having spread and formed a lump that can be felt in clinic. If a lump is found, cells can be sampled in the clinic and checked to see if they relate to your skin cancer.

Melanoma

Following removal of a melanoma, patients are followed up for a suitable period depending on the thickness of their tumour. There are three main reasons you should come back to clinic for your appointments. Firstly to see if your original melanoma has come back, scondly to check for any new lesions or lumps, and thirdly to answer your questions and concerns.

Stage/melanoma type	Follow up
Melanoma in situ	One visit to specialist doctor
Stage 1A	2-4 visits for one year
Stage 1B-2C	3-monthly visits for three years then 6-monthly visits for another two years
Stage 3A-4	As above and yearly visits from five to ten years.

Sun Safety

It is important that, following the diagnosis of any skin cancer, patients think about their attitude to sunshine. It is essential to avoid sun damage, but this does not mean avoiding the sun altogether. Sunshine is important to make the vitamin D to prevent weak bones.

Sun damage can happen even if it is not a very sunny day, and can occur when you are not lying in the sun, but doing other things such as gardening or other outdoor leisure activities. Remember, the sun in other parts of the world, especially closer to the equator, can be even stronger and extra care is needed on holiday or when travelling.

Advice
• Use at least factor 30 (SPF30) on sun exposed areas, and factor 50 (SPF50) if you have a scar exposed. Make sure it has good UVA protection.
• Re-apply sun cream regularly following the guidance on the bottle.
• Seek shade during the hottest part of the day (11am until 3pm).
• Wear a t-shirt, hat and sunglasses.

Supplements

We are not entirely sure how much vitamin D we all need. Most of our vitamin D comes from the sunshine we see in the summer and we make enough to last us through the winter. There are some groups of people who may have lower than normal levels. Pregnant or breastfeeding women, children aged six months to five years, older people and those at risk of not seeing enough sunshine, such as our skin cancer patients. The government recommends a vitamin D supplement for these groups and your local pharmacist can advise you about which supplement is right for you. Remember, sunbeds are NOT a good way to top up your vitamin D levels!

Self-Examination

Following treatment for skin cancer, it can be an anxious time returning for follow-up visits in case your doctor finds something abnormal. It is important that you are part of your follow up by self-examining once a month for any new lumps or swellings, and in the case of squamous cell carcinoma or melanoma, for any lumps in the nearest lymph glands. Your doctor and/or skin cancer nurse will explain how to look after yourself following your surgery and what to look out for should your skin cancer recur. If you are concerned that your skin cancer may have come back you should contact your skin cancer team soon rather than waiting for your next outpatient review.

Cancer Trials

Your doctors and cancer scientists continue to find ways to better treat people with skin cancer. Whenever a new discovery is made, it needs to be carefully tested to understand if it is better than the current treatments. There are trials of new medicine opening all the time and your doctors and nurses will advise you if there is a trial that may be suitable for you.

You will be guided through what the trial is about, whether you need any extra tests and how much time you will need to commit. It is entirely up to you if you want to take part, and importantly, saying ‘no thank you’ does not change your treatment in any way.

Support for Patients

A diagnosis of skin cancer can be very worrying for you and your familybut there is lots of support out there for patients and their families. There can be anxiety around visits to the doctor, looking different following surgery, managing financial pressures and talking about how you feel. Talk to your doctors, nurses or GP and they can guide you.

Specialist nurses, counsellors and clinical psychologists are affiliated to our skin cancer multi-disciplinary teams and many patients find support from these groups very helpful in dealing with new diagnoses, treatment and future plans and support of dependent family.

Introduction
Skin anatomy and types of skin cancer
Causes
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
Surgery and reconstruction
Lymph node surgery

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Skin Cancer Skin anatomy and types of skin cancer Causes Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma Surgery and Reconstruction Lymph Node Surgery Follow-up