Life after melanoma

Most melanomas are caused by exposure to the sun’s UV radiation. After a diagnosis of melanoma, it is especially important to check your skin  regularly and follow SunSmart behaviour. When UV levels are 3 or above, use a combination of the following measures to protect your skin.

Slip on clothing – Wear clothing that covers your shoulders, neck, arms, legs and body. Choose closely woven fabric or fabric with a high ultraviolet protection factor (UPF) rating, and darker fabrics where possible.

Slop on sunscreen – Use an SPF 30 or higher broad-spectrum water-resistant sunscreen. Apply 20 minutes before going out and reapply every two hours, or after swimming, sweating or any activity that causes you to rub it off. For an adult, the recommended amount is 1 teaspoon for each arm, each leg, front of body, back of body, and the face, neck and ears – a total of 7 teaspoons of sunscreen for one application.

Slap on a hat – Wear a broad-brimmed hat that shades your face, neck and ears. Adult hats should have at least a 7.5 cm brim. Hats for children aged under 8 years should have at least a 5 cm brim; hats for children aged 8–12 should have at least a 6 cm brim.

Seek shade – Use shade from trees, umbrellas, buildings or any type of canopy. UV radiation is reflective and bounces off surfaces, such as concrete, water, sand and snow, so shade should never be the only form of sun protection used. If you can see the sky through the shade, even if the direct sun is blocked, the shade will not completely protect you from UV.

Slide on sunglasses – Protect your eyes with sunglasses that meet the Australian Standard AS/NZS 1067. Wraparound styles are best. Sunglasses should be worn all year round to protect both the eyes and the delicate skin around the eyes.

Avoid solariums – Do not use solariums. Also known as tanning beds or sun lamps, solariums give off artificial UV radiation and are banned for commercial use in Australia.

Check daily sun protection times – Use the SunSmart UV Alert to check the recommended sun protection times in your local area every day. It is available as an app, online (sunsmart.com.au or bom.gov.au/uv), in the weather section of daily newspapers, or as a free website widget.

If you have been diagnosed with melanoma, you need to take special care to protect your skin from the sun’s UV radiation. This will reduce your risk of further melanomas.

The UV Index shows the intensity of the sun’s UV radiation. It can help you work out when to use sun protection. An index of 3 or above indicates that UV levels are high enough to damage unprotected skin, so sun protection is recommended. The recommended daily sun protection times are when UV levels are forecast to be 3 or higher. These will vary according to where you live and the time of year.

Sun exposure and vitamin D

UV radiation from the sun causes skin cancer, but it is also the best source of vitamin D, which is needed to develop and maintain healthy bones. The body can absorb only a limited amount of vitamin D at a time. Getting more sun than recommended does not increase your vitamin D levels, but it does increase your skin cancer risk. Most people reach adequate vitamin D levels through incidental exposure to the sun. When the the UV Index is 3 or above, this may mean spending just a few minutes outdoors on most days of the week.

Getting too much UV is not recommended, even for people with too little vitamin D (vitamin D deficiency). After a melanoma diagnosis, you will be at higher risk of further melanomas, and your doctor may advise you to limit your sun exposure as much as possible. In some cases, this may mean you don’t get enough sun exposure to maintain your vitamin D levels. If you are concerned about vitamin D deficiency, talk to your doctor about how to get enough vitamin D while reducing your risk of further melanomas. Your doctor may advise you to take a supplement.

People who have had one melanoma have about five times the risk of developing a new melanoma compared with the average person their age. It is important to be familiar with your skin, examine it for changes and go to your follow-up appointments. At these follow-up appointments, your doctor will examine the area that was treated and your lymph nodes to check that the melanoma hasn’t come back or spread. Your doctor will also check the rest of your skin for any new melanomas.

The follow-up plan will vary depending on the stage – more frequent visits are recommended for people with advanced melanoma. Your doctor can give you more details of your follow-up plan. When a follow-up appointment or test is approaching, many people feel anxious. Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety. Between follow-up appointments, let your doctor know  immediately of any symptoms or health problems.

For most people, early melanoma will not come back (recur) after treatment. The risk of the melanoma returning is higher for people with regional melanoma. Recurrence can occur at the site where the melanoma was removed (locally); in the lymph nodes; or further away in other body sites, such as the lung, liver or brain.

If the cancer returns, your doctor will discuss the treatment options with you. These will depend on where the cancer has recurred, as well as the stage and grade of the cancer. You may be offered immunotherapy, targeted therapy or the option to join a clinical trial.

If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you
pleasure, you may be experiencing depression. This is quite common among people who have had cancer.

Talk to your GP, as counselling or medication—even for a short time—may help. Some people are able to get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council SA operates a free cancer counselling program. Call Cancer Council 13 11 20 for more information

For information about coping with depression and anxiety, call Beyond Blue on 1300 22 4636 or visit beyondblue.org.au. For 24-hour crisis support, call Lifeline 13 11 14 or visit lifeline.org.au.