MelanomaYour guide to best cancer care

It can be overwhelming after being told that you have or may have melanoma (a type of skin cancer). A lot can happen quickly, and you might have lots of questions, like 'What happens next after a diagnosis?'

This support resource can help to guide you, your family, and your friends through this experience.

Information and support

If you need additional information or would like support, you can visit the melanoma page or call Cancer Council on 13 11 20 to talk to an experienced healthcare professional.

For more information about melanoma, visit Cancer Council’s Understanding Melanoma booklet. You can also check out Melanoma Patients Australia or call 1300 884 450. Melanoma Institute Australia also has a lot of useful information.

If you need a translator, call TIS on 13 14 50 or visit the TIS National website.

Symptoms

Your general practitioner (GP) will look at any lesions that are unusual, change or grow quickly. A lesion can be a spot, mole, scab, area of a different colour, lump, growth or anything different on your skin.

Initial tests you may have:

If your GP is concerned, they will refer you to a GP more experienced in skin cancer or to a specialist, or will do one of the following tests:

Referrals

Your GP may treat you or refer you to a GP more experienced in skin cancer or to a specialist such as a dermatologist or surgeon. Specialists are doctors who are highly trained in a particular area of health care

You can bring a family member or friend with you to your appointments.

Timeframes

If melanoma is suspected, a biopsy should be done within two weeks of your first GP appointment.

If needed, referral to a GP more experienced in skin cancer or specialist should happen within two weeks.

If you can’t get an appointment within this time, follow up with your GP.

The specialist will do more tests to see if you have melanoma. Most biopsies sent to a pathology laboratory confirming a melanoma diagnosis happen in general practice. This process of working out if you have a medical problem is called making a diagnosis. If melanoma has been diagnosed, you might have the following:

The pathology testing will give information about the removed melanoma, such as the risk of the melanoma causing problems in the future. For some melanomas with a low risk (early stage) complete excision is adequate, as long as enough normal skin has been removed.

For higher risk melanomas, the specialist may discuss and recommend more tests, to get more information about the cancer such as if it has spread to other areas of the body.

These tests will give the specialist more information about the cancer, such as where exactly it is in your body, if the cancer is growing or has spread, and what stage it is at. This is called staging, which helps to work out the best treatment for you.

You might have a complete excision alone, with a margin of normal skin, or it might be recommended that you have other tests, such as:

Some people may develop a lump in the groin, armpit or neck. This may be due to the presence of melanoma in your lymph nodes. If this happens other tests and procedures that may be considered appropriate include:

Timeframes

Results should be available within two weeks from when you have the tests.

For most people, who have early-stage disease, no further treatment is needed once the melanoma is completely removed.

Your GP or specialist should talk to you about your risk of getting more melanomas and skin cancers. They should discuss a plan so that together you can look out for any melanomas and other skin cancers if they grow as well as discuss prevention of future skin cancers.

For high-risk melanoma, you may need specialised treatments. Your GP and/or specialist will talk to you about your treatment options.

You may be treated by a team of experts, and you may need more than one treatment type to get the best results. The team will work with you and your family or carer to plan your treatment.

You might have one treatment or a mix of treatments:

Surgery. The melanoma and an area around it are cut out and the area stitched up. If the area can’t be stitched up a skin graft/flap will be applied. A skin graft/flap is where healthy skin is removed from another area of the body and moved to a different area. Surgery can be done by a GP experienced in skin cancer, a surgeon or a dermatologist.

Lymph nodes. Sentinel lymph node biopsy and regional lymph node removal should be done by a surgeon in a specialist treatment centre.

Radiation therapy uses X-rays to kill cancer cells and stop the cancer from growing. It might be used alone or after surgery.

Immunotherapy is a type of cancer treatment that helps the body’s immune system to fight the cancer. It can be used if the melanoma has grown and if it has spread to other parts of the body.

Targeted therapy uses drugs to attack specific features of cancer cells and stop the cancer from growing. It can be used if the melanoma has grown and if it has spread to other parts of the body.

For more information, visit Cancer Treatment. Supportive care (treatment or services that support you through a cancer experience) are also available.

Timeframes

Treatment should start within two weeks (surgery) or within four weeks (other treatments) of agreeing to your treatment plan. In some cases, urgent treatment is needed.

You can ask your GP for a referral to another specialist for a second opinion.

For more information on clinical trials, visit the Australian Cancer Trials page.

Recovery

Cancer treatment can cause a range of physical and emotional changes.

Follow-up care plan

Your healthcare team will work with you to make a plan for you and your GP. This plan will explain:

• who your main contact person is after treatment
• how often you should have check-ups and what tests this will include
• understanding and dealing with side effects of treatment
• how to get help quickly if you think the cancer has returned or is worse

Many people worry that the cancer will return. Your specialist and healthcare team will talk with you about your needs and can refer you to other healthcare professionals and community support services.

Other information you may get:

• signs and symptoms to look out for if the cancer returns
• late effects of treatment and the specialists you may need to see
• how to make healthy lifestyle choices to give you the best chance of recovery and staying well

For more information, visit After Cancer Treatment.

For information about skin cancer prevention and early detection, visit the SunSmart page.

Sometimes, cancer can come back after treatment. It can come back in the same place or can appear somewhere different in your body.

If cancer returns, you may be referred to the specialist or the hospital where you were first treated, or to a different specialist.

Treatment will depend on how far the cancer has spread, how fast-growing it might be, and the symptoms you are experiencing.

Advance care planning

Your GP or healthcare team may talk with you, your family, and carer about your future treatment and medical needs.

Advance care directive

Sometimes known as a living will, an advance care directive is a legally binding document that you prepare to let your family and healthcare team know about the treatment and care you might want or not want in case you become too unwell to make those decisions yourself.

For more information, visit Advance Care Planning Australia.

Palliative care

Your specialist may refer you to palliative care services, but this doesn’t always mean end-of-life care. Today, people can be referred to these services much earlier if they’re living with cancer or if their cancer returns. Palliative care can help you to live as well as you can, including managing pain and symptoms. This care may be at home, in a hospital or at another location you choose.

Speak to your GP or specialist or visit Palliative Care Australia.

Making treatment decisions

You may decide not to have treatment at all, or to only have some treatment to reduce pain and discomfort. You may want to discuss your decision with your healthcare team, GP, family and carer.

For more information, visit Advanced Cancer Treatment.

You may have to pay for some appointments, tests, medications, accommodation, travel or parking. Speak with your GP, specialist or private health insurer (if you have one) to understand what is covered and what your out-of-pocket costs may be.

If you have concerns about costs, talk to your healthcare team or a social worker about:

• being bulk-billed or being treated in the public system
• help with accommodation during treatment
• the possible financial impact of your treatment

You can call Cancer Council on 13 11 20 to speak to a healthcare professional about financial support. For more information about costs, visit Practical and financial assistance and What will I have to pay for treatment.