After a melanoma diagnosis: staging, treatment and follow-up in the UK

The first step is usually a diagnostic excision biopsy. The pathologist reports the tumour thickness, whether the surface is ulcerated, how many cells are dividing and whether the edges are clear. These features determine the stage. Depending on the findings, further tests such as scans or sentinel node biopsy may be recommended. NICE guidance on melanoma (NG14) and national protocols guide care, and your case should be discussed at a multidisciplinary team meeting.

Wide local excision removes extra skin around the biopsy scar to reduce the risk of recurrence. The margin depends on the tumour thickness. The wound is closed with stitches, or occasionally a graft or flap in sensitive areas, and a plastic surgeon may be involved. Most operations are done under local anaesthetic as a day case, though some need general anaesthesia.

For some people with thicker or higher-risk melanoma, surgeons identify and remove the first lymph node or nodes draining the area, to check whether cells have spread there. The result guides further treatment and prognosis. It is a surgical procedure with risks, such as swelling and nerve irritation, and your team will discuss whether it is appropriate for you.

For melanoma that has spread or is at high risk of recurrence, modern treatments include immunotherapy and targeted therapies, which have significantly changed outcomes in recent years. Treatment decisions are made by oncology specialists and may involve clinical trials. These therapies are delivered in specialist centres, with side effects monitored carefully.

• Follow-up schedules vary with stage, and some people with very early disease are followed for a shorter period.

• Visits include examining the scar, lymph nodes and the rest of your skin.

• You are taught to check your skin and lymph nodes between appointments.

• Scans are used in higher-risk cases, according to protocols.

• You should know whom to contact if you notice a new lump or lesion.

Anxiety about recurrence is common. Support from clinical nurse specialists, charities and counselling can help. Practical advice includes sun protection, vitamin D sufficiency, and informing close relatives, who may be at higher risk and could benefit from checks. Ask about family screening and genetic advice if several relatives have had melanoma.

Ask what your stage is, what that means for treatment and outlook, what follow-up will look like, who your key worker is and how to contact them. Ask whether your case has been discussed by the multidisciplinary team and whether any clinical trials are relevant. Write down the answers or bring someone with you.

The period between diagnosis and surgery can feel long. Ask whether a clinical nurse specialist has been assigned and how to reach them. Write down your questions before appointments and take someone with you. Check what to expect after wide excision, such as dressings, activity limits and when stitches come out. If you work, ask for a fit note if needed. Charities and online communities can help, though stories vary and your own team is the best source of information about your case.