Melanoma - self-examination

Instruction for self-examination with a melanoma.

Introduction
Because a melanoma was removed from your skin, you are given an instruction by your physician to examine your skin and lymph nodes yourself.

As explained by the doctor treating you, the pathologist, after microscopic examination of the melanoma tissue, measured the thickness of your melanoma, the so-called Breslow thickness. The prospects of cure (prognosis) are derived from this. In your case,  it was an early form of melanoma with a Breslow thickness of 1 millimetre or less than 1 millimetre which is why you have an excellent prognosis for cure. With such good chances for cure and a chance of survival nearing hundred percent, it is not necessary to be checked by a doctor. Patients are able to notice lymph nodes and/or skin defects just as well or even sooner than a doctor.

However, for safety’s sake it is recommended that you inspect your skin and lymph nodes once every 2 months and when in doubt return to the Outpatients’ Clinic until 3 years after the operation. The conditions are that you have to know what to pay attention to and that you know how to reach the Outpatients’ Clinic for an appointment at short notice (within 3 weeks). This explanation and instruction is meant to provide guidance about this.

Self-examination of the lymph nodes
Examination of the lymph nodes has to do with detecting metastases. The chance of metastases is very small with melanomas with a Breslow thickness of 1 millimetre or less. This is also the reason regular checkups by a doctor have been abolished. Examinations show that many patients observe enlarged lymph nodes much sooner than the doctor. With metastases the tumour cells usually occur in the lymph nodes of the armpits, groin or neck, depending on the place in the body where the melanoma was located. Metastases can be detected after a period of time because lymph nodes swell up and do not shrink again. With a normal lymph node you have to imagine a reasonable sized pea, with a swollen lymph node a broad bean of about 1 to 2 centimetres.

Lymph nodes are located under the skin and may only be felt easily in a thin person. For the examination of swollen lymph nodes you have to exert some pressure with your fingers and feel under the skin if there are any solid structures. (the comparison with a pea and a broad bean applies here as well). They are not attached to the underlying tissue and move under the pressure of your fingers. You examine the left armpit with your right hand and vice versa. In particular if the melanoma was located on the torso, it is advisable to examine all lymph node stations. If you had a melanoma on an arm or a leg it will suffice to examine the corresponding armpit or closest part of the groin. The doctor or nurse will show you how to examine the lymph node stations. Self-examination of the lymph nodes may sometimes be easier while taking a shower because of the soap on your skin.

Please take care not to be in haste or distracted so you can pay full attention. If you know how your neck, armpit or groin normally feel it is not so difficult to feel a change. Compare both sides. If you think that the lymph nodes are swollen you can first wait for a period of three weeks. For lymph nodes may also be swollen when they are doing their ‘normal’ work, fighting an infection. If the lymph node still is swollen after three weeks, contact the Outpatients' Clinic to make an appointment at short notice.

Instruction for examination of the skin
When examining the skin, two things are important:

1. changes to existing moles;
2. appearance of new moles.

Existing moles
Existing moles should not: become bigger, change in colour or shape, itch, sting or hurt, have scabs or bleed.
The main focus of inspection of your skin is the chance of a second melanoma. This chance is small: only 3 out of 100 people who have had a melanoma will end up developing a second melanoma. The second melanoma is in general much thinner than the first one.

New moles
People over 30 years old rarely develop new moles. Especially not moles bigger than 5 millimetres. If a mole slowly becomes larger, up to over 5 millimetres, it is advisable to make an appointment for a checkup. If a mole develops which grows fast/quickly becomes thicker, this may be a special type of melanoma, the nodular melanoma. This type of melanoma is rare. It is difficult to provide good information because when people grow older, many develop pigment spots and old-age warts which are completely harmless.

If a rapidly growing mole develops on your skin a checkup is necessary.

Self-examination of the skin
Every two months you choose a quiet moment for self-examination. To inspect the skin you need a large mirror and you also need to be able to see your back in the mirror. Examine the skin of your entire body. Of course you may also ask for help with the inspection of the moles on your back. Of course this has to be the same person all the time.

When inspecting the moles you lightly stroke them to feel whether they feel different than the other moles. A changing mole that may turn into a melanoma often gives a strange sensation, such as an itch or irritation and sometimes a more indefinable feeling.

Examine the scar
In rare cases the melanoma may come back on the location of the scar. This is called a local relapse. In order to detect this, the scar is examined thoroughly for the development of pigment spots and it is felt whether the scar feels smooth and whether there are no small lumps in the underlying tissue. The scar can only be examined thoroughly a few months after the operation.

Edition: April 2010/77