II. How Does a Dermatologist Find a New Melanoma?

• Immediate follow-up following surgery is needed to make sure that the surgical scar is healing well, that you have recovered fully from the treatment • Long-term follow-up is needed to make sure that the original melanoma has not come back or spread to other body parts. Interview with the Experts: 1. Listen to what Dr. Swanson says to his melanoma survivor patients.

• Early-stage melanomas recur very infrequently. Late-stage melanomas recur more often and quicker. • The risk of recurrence generally decreases over time, peaking at a rate between 2 to 5%, but it never get down to zero. • Studies showed that 80% of all the recurrences in stage I melanoma occur within the first 3 years of the diagnosis. The risk of recurrence reaches a low level around 4 years after the initial treatment for patients with Stage I or II melanomas. • Very often, clinicians use the five-year mark as a magical threshold, as the risk of recurrence dramatically decreases 5 years after the treatment of melanoma.

To look for local recurrence, which is defined as melanoma recurs near the surgical scar, your physicians are looking for: • pigmentation within or extending beyond the scar. • bumps, nodules or firm lesions below the scar. • bumps or nodules surrounding or nearby the scar. To look for distant spread, which is defined as melanoma spread to the lymph nodes, or other organs (e.g., lung or liver), your physician will: • palpate or feel the lymph nodes in your groin, armpits, and around the neck • order specific imaging studies, such as CT scan, MRI or PET scan

• It is estimated that 2% to 10% of patients with first melanomas develop second melanomas. • Approximately, 30% of all second melanomas are diagnosed at the same time or within the first 3 months after the initial melanoma was diagnosed. • Approximately 50% of second melanomas are diagnosed within the first year. • For patients with two melanomas, the risk of developing a third melanoma is estimated to be 16% by 1 year and 30% by 5 years. The good news is that the subsequent melanomas are usually detected with a thinner Breslow thickness then the initial melanoma. • That is why patients with a personal history of melanoma should have frequent skin examination by dermatologists and self-examination by patients.

• The answer to this question depends upon the stage of your melanoma. • Patients with early stage (i.e., melanoma in situ or stage I) of melanoma may only need follow-up with their dermatologists. • Patients with intermediate stage (i.e., stage II) or advanced stage (i.e., III or IV) of melanoma may only need follow-up with their medical oncologists, surgeons and dermatologists.

• Your physicians will ask about your overall health, current medications, and the status of any other medical conditions. • Specifically, they may ask about any weight loss, weight gain, and symptoms associated with specific organs. These questions are the initial screening tool for physicians to ensure that melanoma has not spread to any distant organs. • Physicians will perform physical examination. The scope of the examination will vary depending on the specialist you are seeing. • Dermatologists will focus on the skin, performing a total body skin examination, including the scalp and the bottoms of your feet. • Medical oncologists and general internists may listen to your lungs, heart, and abdomen with a stethoscope, and may palpate your abdomen to check for any potential enlargement of your liver or spleen. Depending on the stages of your melanoma, the oncologists may or may not order imaging or lab studies Interview With the Experts: 1. Dr. David Swanson discusses how to find the right dermatologists for ongoing skin care. 2. Dan Latore discusses how to find the suitable physicians

• There are a number of precautions and after-care attentions you can do to achieve better outcomes. • Immediately after surgery (i.e., 7 to 14 days after the surgery), avoid strenuous activities and exercises, and allow the wound to heal. These activities may increase the risk of infection or sutures busting open, all the complications that will slow wound healing and can give more noticeable scars. • Keep the surgical site moist with Vaseline or Aquaphor ointment. During this period, dried or scabbed wounds take longer to heal. • Treatment modalities include injecting steroids, additional surgery, and laser can improve the appearance of scars. • Remember, a tincture of time heals all wound. Scars tend to fade and heal better over time. Interview with the Expert: