What follow-up care should I provide for patients who have been treated for melanoma?

Follow-up care for patients treated for melanoma should be personalised based on the stage of melanoma and individual risk factors.

Patients with stage IA melanoma should be offered follow-up for 1 year, typically involving 2 clinic appointments in the first year, with discharge at the end of year 1. Routine screening investigations such as imaging and blood tests are not routinely offered for this group.

For stages IB to IV melanoma, follow-up is recommended for 5 years. The frequency of clinic appointments and imaging varies by stage:

• Stage IB: 2 clinic appointments in year 1, with consideration of 2 ultrasound scans of the draining nodal basin if sentinel lymph node biopsy (SLNB) was considered but not done; years 2 and 3 involve 1 clinic appointment and possibly 1 ultrasound scan annually; years 4 and 5 involve 1 clinic appointment annually with discharge at year 5.
• Stage IIA: 2 clinic appointments and possibly 2 ultrasound scans annually in years 1 and 2; 1 clinic appointment and possibly 1 ultrasound scan in year 3; 1 clinic appointment annually in years 4 and 5 with discharge at year 5.
• Stages IIB and IIC: More intensive follow-up with 4 clinic appointments and 2 whole-body and brain contrast-enhanced CT (CE-CT) scans annually in years 1 and 2; continued clinic appointments and imaging in year 3; reduced frequency in years 4 and 5 with discharge at year 5.
• Stages IIIA to IIIC (not on adjuvant therapy): 4 clinic appointments and 2 whole-body and brain CE-CT scans annually in years 1 to 3; 2 clinic appointments and 1 CE-CT scan annually in years 4 and 5 with discharge at year 5.
• Stage IIID and resected stage IV (not on adjuvant therapy): 4 clinic appointments and 4 whole-body and brain CE-CT scans annually in years 1 to 3; 2 clinic appointments and 2 CE-CT scans annually in years 4 and 5 with discharge at year 5.
• Patients on adjuvant therapy: Follow-up should be based on therapeutic requirements.

Ultrasound scans of the draining nodal basin are considered if SLNB was considered but not performed. Whole-body and brain MRI is preferred over CE-CT for children, young adults (up to 24 years), pregnant women, and those with brain metastases or resected brain metastases.

Follow-up appointments should include full examination of the skin and regional lymph nodes by healthcare professionals skilled in skin cancer and lymph node examination, with access to dermoscopy and medical photography.

Patients should be provided with direct contact details for specialist skin cancer services for advice on concerns related to melanoma and offered psychosocial support at all follow-up appointments.

Local follow-up policies should reinforce advice on self-examination, health promotion including sun awareness, vitamin D supplementation advice, and smoking cessation support.