After a melanoma diagnosis, feelings of worry, fear, or anxiety can be overwhelming. To find out what can help ease these feelings, researchers talked with thousands of melanoma patients and survivors. Here’s what they said helps bring peace of mind.

1. Take care of your emotional needs. Patients often say a cancer diagnosis feels overwhelming because it can affect every area of your life. Getting emotional support can help you cope.
   
   
   
   Where you can find help:

• Call your local hospital. Ask if psychological services are available for cancer patients and survivors.

• Contact the Cancer Support Community’s Helpline. Counselors are available Monday through Friday from 9:00 a.m. to 9:00 p.m. Eastern Time.
  
  
  
  You can reach a counselor by:
  
  Phone: 1-888-793-9355
  
  Live chat:

2. Find something positive about your diagnosis. This may seem impossible now, but research suggests it really can help.
   
   
   
   In one study, patients who found something positive about their melanoma diagnosis were more satisfied with life. Two years after their diagnosis, they were also more likely to be more mentally alert. Those who found something positive kept their language skills, ability to reason, memory, and focus. Those who didn’t find something positive lost ground in these areas.
   
   
   
   Ideas that can help: If it seems there’s nothing positive about your diagnosis, here are some positive things that melanoma survivors say happened after their diagnosis:

• Gave me a greater appreciation for life
• Made me realize what’s important in life for me
• Let’s me spend more time doing what matters most, such as spending time with family or doing activities that make me happy
• Causes me to care less about everyday annoyances

3. Consider massage therapy: Studies suggest that massage can help cancer patients. A study at Memorial Sloan-Kettering Cancer Center found that patients who received massage therapy felt better. They had 50% less pain, anxiety, fatigue, and nausea. These effects lasted up to 48 hours.
   
   
   
   As a result of this study, a few insurance companies now cover massage therapy during cancer treatment.

3. Try mind-body therapies: Research studies show that mind-body therapies can help cancer patients relax and feel better. Examples of mind-body therapy include meditation, yoga, biofeedback, and prayer.
   
   
   
   In one study, researchers found women who focused on calming thoughts while on chemotherapy had a better quality of life.

3. Find the right dermatologist for you. Melanoma survivors say it’s important to find a dermatologist with expertise in treating melanoma and with whom you feel comfortable.
   
   
   
   If you feel uncomfortable with your dermatologist or don’t have a dermatologist, you can find one by going to .

3. Protect your skin from the sun and avoid tanning beds. While lying in the sun may feel relaxing, protecting your skin from the sun and avoid tanning beds can help you stay as healthy as possible.
   
   
   
   Melanoma survivors say that having (had) melanoma motivates them to protect their skin. Many want to stay alive to care for their family. Others want to set a good example for their children, so they take sun protection seriously.
   
   
   
   In studies, some melanoma survivors said that being caught outdoors without sun protection makes them feel extremely anxious. To avoid this feeling, they plan ahead.

3. Check your skin for signs of skin cancer and keep all follow-up appointments with your dermatologist. Studies suggest that after treatment, taking action to find melanoma early may ease anxiety and depression.
   
   
   
   Some survivors say they see a dermatologist because it’s an effective way to find a new melanoma early before it has a chance to spread.
   
   
   
   One survivor had this say about dermatology follow-up appointments, “I have this feeling of relief, even if she [dermatologist] finds something, because it’s going to be taken care of.”

If all of this seems overwhelming right now, try starting with one thing, such as thinking about the positive things you’re doing to fight your cancer.

Image: Thinkstock

References

Bonnaud-Antignac A, Bourdon M, et al. “Coping strategies at the time of diagnosis and quality of life 2 years later: A study in primary cutaneous melanoma patients.” Cancer Nurs. 2017;40(1):E45-E53.

Cassileth BR, Vickers AJ. “Massage therapy for symptom control: outcome study at a major cancer center.” J Pain Symptom Manage. 2004;28(3):244-9.

Oliveria SA, Shuk E, et al. “Melanoma survivors: Health behaviors, surveillance, psychosocial factors, and family concerns.” Psychooncology. 2013;22(1):106-16.

Poole, CM. “Tending to your spirits.” In: Melanoma — Not just skin cancer. South Carolina: CreateSpace Independent Publishing Platform; 2015:115-27.

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If you’re worried about getting melanoma, the most-serious skin cancer, you may be wondering whether you should have genetic testing. After all, genetic testing is now used find a person’s risk for many diseases.

Before getting a genetic test for melanoma, here are some facts you should know:

Few people will have a positive genetic test

The genetic test for melanoma can tell you whether you have a mutation (change) in a gene that gives you an increased risk of developing melanoma. These mutations are passed down in the family tree.

If you carry one of these mutations, your lifetime risk of getting melanoma ranges from 60% to 90%. Only about 10% of people who develop melanoma have one of these genes.

Most people get melanoma for other reasons. The sun, tanning beds, and tanning lamps give off ultraviolet (UV) rays. These rays are known to damage our skin. This damage can cause different types of skin cancer, including melanoma.

We also know that certain physical traits increase a person’s risk of getting melanoma. Physical traits that can increase your risk of getting melanoma include having skin that burns easily but rarely tans, naturally blonde or red hair, or blue or green eyes.

Having red hair and freckles may double or triple your risk of getting melanoma.

If you have 50+ moles or atypical moles, you also have an increased risk. An atypical mole looks different — more like a melanoma. Atypical moles also have a higher risk of becoming a melanoma.

Getting 5 or more blistering sunburns between the ages 15 and 20 increases your risk of getting melanoma by 80%.

You also have a higher risk of getting melanoma if you have a suppressed immune system. Some medications suppress your immune system. These include chemotherapy medications and those taken after receiving an organ transplant.

Being 50 years of age or better also increases your risk of developing melanoma.

So as you can see, people get melanoma for many reasons. It’s likely that many people who get melanoma have more than one cause at work.

Genetic testing may be recommended when you have one of these risks

In the United States, a dermatologist may consider genetic counseling and possibly genetic testing for melanoma if you have had one (or more) of the following:

• 3 or more melanomas that have grown deep into your skin (or spread), especially if one melanoma was diagnosed before your 45^th birthday
• 3 or more blood relatives on one side of your family who have had melanoma or cancer of the pancreas
• 2 or more unusual-looking moles called Spitz nevi
• 1 or more Spitz nevi and a close blood relative has (or had) mesothelioma (a type of cancer), meningioma (a type of brain tumor), or melanoma of the eye¹

Positive genetic test for melanoma can provide important information

A genetic test for melanoma can tell you about more than your melanoma risk. People who carry a mutation on a gene known as CDKN2A have a higher risk of developing melanoma, cancer of the pancreas, or a tumor in the central nervous system.

A mutation on the gene called BAP1 means a higher risk of getting melanoma, melanoma of the eye, or cancers like mesothelioma and kidney cancer.

A genetic test cannot tell you whether will develop one of these cancers.

But knowing these risks can be helpful. It can help people get needed cancer screenings.

A positive test for melanoma can also help your dermatologist monitor you for signs of skin cancer. Patients with a high risk may need more frequent skin cancer screenings. Total body photography can show changes to your moles, which can help find a melanoma in its earliest stage.

A positive test also has some drawbacks. It causes some people to feel anxious and worried. Some people worry that an insurance company may discriminate against them.

Negative test can give you a false sense of security

If the test shows that you don’t have a gene mutation for melanoma, that’s great news. But it doesn’t mean that you cannot get melanoma. More people are diagnosed with melanoma than ever before. Most of them, 90%, don’t have a gene mutation that increases their risk.

Dermatologists caution that everyone needs to . You still need to . And you should keep all follow-up appointments with your dermatologist.

A dermatologist can tell you about your risks

If you’re still wondering whether you should have genetic testing for melanoma, you may want to talk with your dermatologist. By talking about your concerns and risks, your dermatologist can help you decide whether this test would be helpful.

If genetic testing may be an option for you, your dermatologist can refer you to a qualified genetic counselor. A genetic counselor can talk with you about the benefits and limitations of testing.

¹ Swetter SM, Tsao H, et al. “.” J Am Acad Dermatol. 201. Articles in press.

Images: Thinkstock

References

Leachman SA, Carucci J, et al. “Selection criteria for genetic assessment of patients with familial melanoma.” J Am Acad Dermatol. 2009 Oct;61(4):677e1-14.

National Comprehensive Cancer Network. “NCCN Guidelines (version 1.2017) Melanoma. Last accessed March 27, 2017.

Ransohoff KJ, Jaju PD, et al. “Familial skin cancer syndromes: Increased melanoma risk.” J Am Acad Dermatol. 2016;74(3):423-34.

Swetter SM, Tsao H, et al. “.” J Am Acad Dermatol. 201. Articles in press.

Van Voorhees A. “What should you know about hereditary melanoma?” Dermatology World. 2016; 26(7):20-4.

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Researchers have found yet another way that men and women differ. Melanoma, the most-serious skin cancer, affects the sexes differently.

Men are more likely to die of melanoma than women. This is true at any age. White adolescent males and young adult men are about twice as likely to die of melanoma as are white females of the same age.

By age 50, men are also more likely than women to develop melanoma. This number jumps by age 65, making men 2 times as likely as women of the same age to get melanoma. By age 80, men are 3 times more likely than women in that age group to develop melanoma.

Why melanoma seems to strike men harder

One reason may be that men know less about skin cancer. A survey conducted by the American Academy of Dermatology in 2016 found that fewer men than women knew the following facts:

With less knowledge, it’s natural that men are less likely to protect their skin from the sun.

We also know that women apply sunscreen more often than men. Women also use makeup and other cosmetics that offer SPF. So sun protection seems to play a role in why melanoma strikes men harder.

Sun protection alone, however, doesn’t seem to account for the differences.

Researchers believe that a major cause may lie in men’s skin. We know that men’s skin differs from women’s skin. Men have thicker skin with less fat beneath. A man’s skin also contains more collagen and elastin, fibers that give the skin firmness and keep it tight.

Research shows that these differences make men’s skin more likely to be damaged by the sun’s ultraviolet (UV) rays. A study conducted in the Netherlands found that men’s skin reacted more intensely to UV rays than did women’s skin. A separate study reached the same conclusion.

Research also shows that a women’s skin may be better at repairing the damage caused by UV rays.

Sun protection can lower men’s risk of getting melanoma

While sun protection alone cannot explain why men are hit harder, we know that it can reduce the risk of getting melanoma.

Men who dislike applying lotions and creams can still protect their skin from the sun. When outdoors, even on cloudy days, men can:

• Put on a wide-brimmed hat and sunglasses.
• Seek shade whenever possible.
• Wear long sleeves and pants when possible.
• Stay out of the sun when the sun’s rays are strongest (from 10 a.m. to 2 p.m.)

It’s a proven fact that sunscreen also helps. Sunscreen can protect skin not covered by clothing.

To encourage men to wear sunscreen, there are sunscreens formulated just for men. To get the needed sun protection, the AAD recommends wearing sunscreen that offers SPF 30, broad-spectrum protection, and water resistance.

Skin exams can reduce men’s risk of dying of melanoma

Found early, melanoma is highly treatable. Skin self-exams can help men find skin cancer early. Of course, it helps to have your partner check hard-to-see areas like your backside.

Getting your partner involved can also make skin exams more fun. With a partner’s help, a skin exam may even become something that you look forward to.

You’ll find a video that shows how a partner can help you check your skin for signs of skin cancer at

If you’ve never been screened for skin cancer, now is an excellent time to start. Screenings can help find early signs of skin cancer.

The AAD offers free SPOTme^® skin cancer screenings. Most take place in the spring. If you don’t find a free screening in your area, you can sign up for an e-mail alert, which will let you know when a screening is scheduled in your area.

You can find out whether a screening is being offered in your area at

Men: It’s time to strike back vs. melanoma

While you cannot change how your skin reacts to the sun, sun protection can reduce your risk of getting melanoma. You can also strike back with skin self-exams and skin cancer screenings. These can help you find melanoma early when melanoma is highly treatable.

References

American Academy of Dermatology. “” News release issued April 28, 2016. Last accessed February 28, 2017.

American Academy of Dermatology. . Last accessed February 28, 2017.

American Cancer Society. “.” Last accessed February 28, 2017.

Gamba CS, Clarke CA, et al. “Melanoma survival disadvantage in young, non-Hispanic white males compared with females.” JAMA Dermatol. 2013;149(8):912-20.

Liu-Smith F, Farhat AM, et al. “Sex differences in the association of cutaneous melanoma incidence rates and geographic ultraviolet light exposure.” J Am Acad Dermatol 2017;76:499-505.

Additional related resources

• ​

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If you have advanced melanoma, this means the cancer has spread. Surgery alone cannot remove the cancer. You’ll need other treatment.

One option that your doctor may talk about is combination therapy. It involves using two or more treatments at the same time to fight the cancer. This approach helps to attack the cancer in different ways.

One type of combination therapy is helping some patients with advanced melanoma. It involves taking two of the newer treatments for advanced melanoma. Results from clinical trials show that this approach can stop the cancer from spreading for longer than ever before. The combinations are also working for more patients, so more patients with advanced melanoma are living longer.

Receiving two drugs instead of one is also giving a few more patients complete clearing of their cancer. The number of patients with no sign of cancer, however, is still small.

Because of these breakthroughs, the U.S. Food and Drug Administration (FDA) has approved 3 combinations of these newer medications to treat advanced melanoma.

To be eligible to receive some of these approved combinations, the patient must have a BRAF-gene mutation. About half the people diagnosed with melanoma have a BRAF-gene mutation.

Your doctor can test you for a BRAF-gene mutation by taking a sample from a melanoma tumor.

FDA-approved combination therapies for advanced melanoma

Tell your doctor about all the side effects

If you and your doctor decide that one of these combinations treatments is right for you, it’s important to pay attention to side effects. If you develop any side effect, tell your doctor immediately. Some side effects can be reversed if caught early, so you won’t have to stop treatment.

It’s also important for your doctor to know about all side effects because some can be quite serious. About 30% of patients stop treatment due to side effects.

How you’ll know if the treatment works

Your doctor will examine you often. You will also have medical tests. Scans can show whether the cancer is shrinking. Blood tests will tell your doctor how your body is reacting to the treatment.

Could this be a treatment option for you?

If you want to know whether one of these FDA-approved combinations might be an option for you, ask the doctor treating you for melanoma.

Image: Thinkstock

References

Duan L, Mukherjee EM, et al. “Tailoring the treatment of melanoma: Implications for personalized medicine.” Yale J Biol Med. 2015; 88(4):389-95.

Guo C, McQuade JL, et al. “Clinical, molecular and immune analysis of dabrafenib and trametinib in metastatic melanoma patients that progressed on BRAF inhibitor monotherapy: a phase II clinical trial.” JAMA Oncol. 2016; 2(8):1056-64.

Larkin, J, Ascierto PA, et al. “Combined vemurafenib and cobimetinib in BRAF-mutated melanoma.” N Engl J Med 2014; 371:1867-76.

Patel AB and Patterson S. (2017, March). Update on cutaneous reactions to targeted and immune cancer therapy. In Patel AB (Director), “Cutaneous adverse events to immune checkpoint inhibitor therapy.” Focus session presented at the Annual Meeting of the American Academy of Dermatology, Orlando, FL.

U.S. Food and Drug Administration [news releases]:

• (November 10, 2015) “.” Lasted accessed February 15, 2017.
• (January 10, 2014) “.” Lasted accessed February 15, 2017.

U.S. Food and Drug Administration. “b.” [approved drugs]. Lasted accessed February 15, 2017.

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Melanoma is a type of skin cancer that can spread quickly. When melanoma starts to spread, it often travels to a lymph node near the melanoma first.

Having a sentinel lymph node biopsy (SLNB) can tell whether cancer cells have spread to a nearby lymph node. If the cancer has spread to a lymph node, you have stage III melanoma. Knowing the stage of your cancer helps your doctors create an appropriate treatment plan for you.

What exactly is a SLNB?

It’s a type of surgery that’s performed in an operating room. During this surgery, the surgeon makes a small incision and removes one or a few lymph nodes. These nodes are tested to see if they contain cancer cells.

When would a doctor recommend a SLNB?

Your doctor may recommend a SLNB if you have an increased risk of melanoma spreading to a lymph node. Melanoma has a greater risk of spreading to the nearest lymph nodes when it:

• Grows to a certain thickness in the skin
• Has cells that are dividing quickly
• Breaks open (If it broke open, it may have looked like a sore on your skin.)

A doctor can tell if melanoma has any of these risks by reading your biopsy report.

A SNLB is only recommended when you have a high risk of melanoma spreading and your doctor did not feel any enlarged lymph nodes when examining you.

If your doctor felt any enlarged lymph nodes, you need different testing.

When would a patient have a SLNB?

Most patients have a SLNB when they have their melanoma surgery.

The melanoma surgery differs from the skin biopsy. You had a skin biopsy when your dermatologist (or another doctor) removed what looked like a melanoma from your skin.

For patients with melanoma, the next step after a skin biopsy is usually melanoma surgery. During melanoma surgery, the goal is to remove any remaining cancer. If your melanoma is thin, your dermatologist may perform the melanoma surgery in a medical office or surgical suite while you are awake.

Patients who have an early, thin melanoma do not need to have a SLNB.

If the melanoma is thick or has spread, you may be treated in an operating room. A SLNB is also performed in an operating room.

What happens during a SLNB?

A SLNB begins with finding the sentinel lymph node(s). This is the first lymph node(s) that cancer cells are likely to reach. You’ll be awake during this part.

To find your sentinel lymph node(s), you may receive an injection of a radioactive solution or blue dye. Some surgeons prefer to use both, so you’ll receive 2 injections.

If your surgeon wants to use a radioactive solution, you’ll receive the injection hours before the surgery — or even the day before. The dye, which stains your sentinel lymph nodes blue, is injected right before the surgery.

Just before the surgery to remove the sentinel lymph node(s), you’ll receive anesthetic that puts you to sleep.

In the operating room, your surgeon first needs to find your sentinel nodes. If you received a radioactive solution, your surgeon uses a handheld device called a gamma detector to find the radioactive lymph nodes. If dye was injected, your surgeon looks for the blue lymph nodes. Once found, your surgeon removes the radioactive (or blue) lymph nodes. These will be sent to a lab where they can be examined for cancer cells.

While you are in the operating room, you may also have melanoma surgery.

After the surgery(ies), you will be moved to a recovery room, where you’ll be watched. Many patients go home the same day. Some need to spend the night in the hospital.

What happens if cancer cells are found?

If cancer cells are found in the removed lymph nodes, your melanoma stage changes. Once the cancer travels to nearby lymph nodes, it is a stage III melanoma.

If you have stage III melanoma, your doctor will talk with you about your treatment options.

Are there any risks in having a SLNB?

Every surgery has risks. After a SLNB, you may have numbness, pain, or bruising where the lymph node(s) was removed. You may also have a buildup of fluid in the area. Sometimes, the skin in the area where you had the SLNB feels hard or thick. This can make it difficult to move that part of your body. These side effects tend to be temporary.

Some patients have an allergic reaction to the blue dye. A few patients have developed a life-threatening allergic reaction.

If you have any allergies, tell your doctors before having a SLNB.

With any surgery, you can develop an infection. Following the instructions given to you after the surgery can reduce this risk.

SLNB tells you one thing

A SLNB can only tell you whether cancer cells have spread to the lymph nodes nearest the melanoma. This is where melanoma usually travels to first when it starts to spread. A SLNB cannot tell you whether cancer cells have spread elsewhere.

Ultimately, the decision about whether to have a SLNB is up to you. Your doctor can help you decide by answering your questions.

Image

Thinkstock

References

Cooper C, Wayne JD, et al. “A 10-year, single-institution analysis of clinicopathologic features and sentinel lymph node biopsy in thin melanomas.” J Am Acad Dermatol. 2013;69(5):693-9.

Faries MB, Cochran AJ, et al. “Multicenter Selective Lymphadenectomy Trial-I confirms the central role of sentinel node biopsy in contemporary melanoma management.” Br J Dermatol. 2015;172(3):571-3.

Gerami P, cook RW, et al. “Gene expression profiling for molecular staging of cutaneous melanoma in patients undergoing sentinel lymph node biopsy.” J Am Acad Dermatol. 2015;72(5):780-5.

Leung AM, Morton DL, et al. “Staging of regional lymph nodes in melanoma: a case for including non-sentinel lymph node positivity in the American Joint Committee on Cancer staging system.” JAMA Surg. 2013;148(9):879-84.

Liang MI and Carson WE. “Biphasic anaphylactic reaction to blue dye during sentinel lymph node biopsy.” World J Surg Oncol. 2008;6:79.

Lima Sánchez J, Sánchez Medina M, et al. “Sentinel lymph node biopsy for cutaneous melanoma: a 6-years study.” Indian J Plast Surg. 2013;46(1):92-7.

Morton DL, Thompson JF, et al. “Final trial report of sentinel-node biopsy versus nodal observation in melanoma.” N Engl J Med. 2014;370(7):599-609.

Wat H, Senthilselvan A, et al. “A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas.” J Am Acad Dermatol. 2016;74(1):94-101

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If you’ve been treated for melanoma, you may never get another melanoma. Many people don’t. But it’s important to know that you have a greater risk of getting another one. Anyone who has had melanoma has this risk.

Melanoma can also come back after treatment. The risk of melanoma returning is greater if you had a melanoma that:

• Was thick
• Looked like an open sore (bleeding and forming scabs before it was treated)
• Was surrounded by other melanomas
• Spread to one or more lymph nodes

Why does melanoma return?

Like any cancer, melanoma returns when some cancer cells survive treatment. Your dermatologist or oncologist (doctor who specializes in treating cancer) does everything possible to prevent this. Sometimes, however, cancer cells survive.

If cancer cells survive, they may multiply and grow into a melanoma. The medical term for this is recurrence.

Where does melanoma return?

It may come back in the same place or on the same area of your body. This is most common.

Melanoma can also return far from where you had the first one. For example, if you had a melanoma on your back, it could return on your arm.

It can also show up inside your body. If melanoma appears inside the body, it’s most likely to show up in the lymph nodes, lungs, liver, brain, bone, or gastrointestinal (GI) tract.

How can a returning melanoma appear in a new place?

Melanoma spreads when cancer cells break off from the original melanoma. When the cells break off, they may stay where they are or travel to another part of the body.

Because the cancer cells are from the original melanoma, the cancer is said to have returned. This is true even if the returning melanoma appears far from the original melanoma.

When does melanoma return?

Melanoma is most likely to return within the first 5 years of treatment.

If you remain melanoma free for 10 years, it’s less likely that the melanoma will return. But it’s not impossible. Studies show that melanoma can return 10, 15, and even 25 years after the first treatment. This happens less often.

Best defense: Lifelong skin exams and UV protection

While it can be upsetting to know that you have a higher risk of getting another melanoma, there is good news:

• Skin exams can help you find melanoma early when it can be successfully treated.
• Protecting your skin from harmful ultraviolet (UV) rays can reduce your risk of getting another skin cancer, including melanoma.

Skin exams: Two types of skin exams are essential — 1) Monthly and 2) follow-up exams with your dermatologist. These exams can help find another melanoma early, when it can be treated successfully.

Even when your dermatologist examines you, skin self-exams are important. In one study, patients were the first to find 73% of their returning melanomas.

If you’re unsure of how to check your skin (and lymph nodes), tell your dermatologist. Even if the reason is poor eyesight or an inability to check certain areas of your body, it’s important for your dermatologist to know this. Dermatologist often have ways to solve such problems.

Skin self-exams are so important that they’re recommended for life.

You also want to keep all follow-up appointments with your dermatologist (or oncologist). These exams are recommended every 3 to 6 months for at least the first year after treatment.

After that, your dermatologist (or oncologist) will tell you how often you need to be seen. For many patients, it’s once every 6 or 12 months. These exams are also recommended for life.

UV protection: This means protecting your skin and eyes from harmful UV light, which comes from the sun, tanning beds, and tanning lamps.

You can reduce your risk of getting another melanoma by always protecting your skin from the sun.

If you’re unsure about how to protect your skin from UV light, be sure to ask your dermatologist.

It’s normal to feel anxious

Knowing that you may get another melanoma can leave anyone feeling anxious or worried. In the beginning, any change to your body may convince you that you have another melanoma.

Taking action can help ease your mind. Examining your own skin and keeping all follow-up appointments can help you find signs of skin cancer as early as possible. Protecting yourself from harmful UV rays helps to reduce your risk of getting another skin cancer, including melanoma.

In time, these healthy habits should begin to feel normal and help reassure you that if melanoma returns or you get another one, it will be found early.

References

Benvenuto-Andrade, Oseitutu A, et al. “Cutaneous melanoma: Surveillance of patients for recurrence and new primary melanomas.” Dermatol Ther. 2005 Nov-Dec;18(6):423-35.

Faries MB, Steen S, et al. “Late recurrence in melanoma: clinical implications of lost dormancy.” J Am Coll Surg. 2013 Jul;217(1):27-34.

Francken AB, Shaw HM, et al. “Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines.” Ann Surg Oncol. 2007 Jun;14(6):1924-33.

Paek SC, Sober AJ, et al. “Cutaneous melanoma.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1156-7.

Uliasz A and Lebwohl M. “Patient education and regular surveillance results in earlier diagnosis of second primary melanoma.” Int J Dermatol. 2007 Jun;46(6):575-7.

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