Improving outcomes for people with skin tumours including melanoma

For patients with low-risk BCC or SCC the majority of recurrences
can be cured if identified early. In addition, patients with low-risk
BCC or SCC are at low risk of recurrence and extremely low risk of
mortality, and the majority of these patients will be suitable
candidates for self-follow-up. Clinicians should be aware that,
because of their mental or physical state, not all patients will be able
to perform self-examination.
Improving Outcomes for
People with Skin Tumours
including Melanoma
Follow-up
Ideally, RCTs of the effectiveness of prolonged follow-up should be
the gold standard against which decisions on follow-up strategy are
made. In the absence of these, the factors that need to be taken into
account are:
• the risk of recurrence or development of metachronous (new
primary) disease
• whether there is any evidence that clinicians detect recurrent or
metachronous disease at an earlier stage than patients, whether
treatment of this earlier stage disease is more effective, and
whether patients can be trained to detect recurrence or new
disease as well as doctors.
Follow-up of skin cancer patients accounts for a significant
proportion of outpatient clinic time. The main aims of follow-up are
different in the immediate post-treatment phase and in the longer
term. Short-term follow-up (less than 6 months) is important for:
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• patient education, especially regarding sun protection measures
and early recognition of new and recurrent lesions
• provision of help, and rehabilitation for patients suffering from
complications and side-effects of treatment, e.g. scars,
lymphoedema
• provision of psychological and emotional support to patient,
carer and family
• the evaluation of surgical outcome through audit.
Long-term follow-up (more than 6 months) is usually aimed at:
• identifying locoregional or distant recurrence
• identifying metachronous disease.
Guidance on cancer services: skin tumours including melanoma
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