What’s the Plan for Patients With Melanoma After Surgery?

Patients with melanoma that is fully resectable (meaning it can be removed via surgery) and their care teams need to remain vigilant in case of possible disease recurrence or metastasis (when cancer spreads to other parts of a patient’s body).

“Patients often worry that there’s going to be a new melanoma that occurs on their skin and so they’re checking their skin very diligently,” Dr. Justine V. Cohen, a medical oncologist with the Dana-Farber Cancer Institute in Boston, told CURE®. “And that is true. Once a patient has a melanoma, there is about a 10% chance that they will develop another melanoma in their lifetime. And they should be very cautious in the sun; we say don’t go out during the hours of 10 a.m. to 4 p.m. in direct sunlight without protection (and) without wearing sun protection and sunscreen and a wide-brimmed hat and long sleeves and long pants.”

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But, Cohen cautioned, risks are present inside a patient’s body as well as on their skin.

“When we talk about recurrence of melanoma, we actually worry more about what we cannot see, what’s on the inside,” Cohen said. “And so, it’s true that a patient can develop another melanoma on their skin, but we worry about that melanoma’s risk of metastasizing. So, the cells leak out and they travel to the lungs or the liver or the brain and you can’t see those. And that’s why it’s important to follow up with an oncologist because we might have ways of detecting that by asking questions, by doing physical exams, by checking scans and by checking bloodwork.”

Standards of post-surgical care and monitoring differ by what stage of melanoma a patient has had, as Cohen explained.

“Depending on the depth of their melanoma and the involvement with lymph nodes or not, that will determine the surveillance plan and/or adjuvant (post-surgical) treatment plan,” Cohen said. “So adjuvant treatment is giving therapy systemic therapy throughout the body in the post-surgical setting, in order to reduce the risk of it coming back.”

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After surgery, they see the surgeon and they almost always see a medical oncologist. The medical oncologist will determine if they have a stage 1, 2 or 3 melanoma or (stage) four that was still able to be surgically removed, and that medical oncologist will determine the plan. (The) first question is, “What is their risk of recurrence, and do they need a therapy to reduce that risk of recurrence?”

If they don’t (need adjuvant therapy), they will move into what’s called a surveillance plan. And that surveillance plan is dependent on the stage. So, (patients with) stage 1 melanomas, for example, do not get scans, they don’t get CT scans or PET scans, but (for patients with) stage 2 and 3 melanomas, we often do CTs or PET scans in in our surveillance. Most patients, though, are seen by the oncologist anywhere from one to four times a year when they’re in surveillance.

Transcript has been edited for clarity and conciseness.

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