Follow-up
Source-checked 14 May 2026. Stage-specific surveillance per NICE NG14 §1.9.15 (melanoma), BAD cSCC and BCC guidance, and ESMO-EURACAN MCC 2024. Self-examination, second-primary risk, OTR pathways, recurrence triage, late-effect surveillance and end-of-life care.
Melanoma — NICE NG14 §1.9.15
Stage-stratified cadence is the UK standard. Stage 0 has a single advice visit in the first year. Routine follow-up is 1 year for stage IA and 5 years for stages IB to resected IV. Personalised follow-up is required for unresectable stage III / IV disease and may be appropriate for people at increased risk of further primary melanomas.
| Stage | Cadence (per NG14 §1.9.15) |
|---|---|
| Stage 0 (in situ) | One clinic advice visit during the first year after treatment, then discharge. No routine surveillance imaging. |
| Stage IA | Year 1: consider 2 clinic appointments; discharge at end of year 1. Do not routinely offer imaging or blood tests. |
| Stage IB | Year 1: 2 clinic appointments. Years 2-3: 1 clinic appointment per year. Years 4-5: 1 clinic appointment per year; discharge at end of year 5. If SLNB was considered but not done, consider 2 nodal-basin ultrasound scans in year 1 and 1 per year in years 2-3. |
| Stage IIA | Years 1-2: 2 clinic appointments per year. Year 3: 1 clinic appointment. Years 4-5: 1 clinic appointment per year; discharge at end of year 5. If SLNB was considered but not done, consider 2 nodal-basin ultrasound scans per year in years 1-2 and 1 scan in year 3. |
| Stage IIB | Years 1-2: 4 clinic appointments per year and consider 2 whole-body and brain CE-CT scans per year. Year 3: 2 clinic appointments and consider 2 CE-CT scans. Years 4-5: 1 clinic appointment and consider 1 CE-CT scan per year; discharge at end of year 5. If SLNB was considered but not done, consider 2 nodal-basin ultrasound scans per year in years 1-2 and 2 scans in year 3. |
| Stage IIC | Years 1-2: 4 clinic appointments and 2 whole-body and brain CE-CT scans per year. Year 3: 2 clinic appointments and 2 CE-CT scans. Years 4-5: 1 clinic appointment and 1 CE-CT scan per year; discharge at end of year 5. If SLNB was considered but not done, consider 2 nodal-basin ultrasound scans per year in years 1-2 and 2 scans in year 3. |
| Stage IIIA-IIIC, not on adjuvant therapy | Years 1-3: 4 clinic appointments and 2 whole-body and brain CE-CT scans per year. Years 4-5: 2 clinic appointments and 1 CE-CT scan per year; discharge at end of year 5. If the sentinel node was positive, consider 2 nodal-basin ultrasound scans per year in years 1-3. |
| Stage IIID / resected IV, not on adjuvant therapy | Years 1-3: 4 clinic appointments and 4 whole-body and brain CE-CT scans per year. Years 4-5: 2 clinic appointments and 2 CE-CT scans per year; discharge at end of year 5. |
| Stage IIIA-IIIC, IIID or resected IV on adjuvant therapy | During adjuvant therapy, base follow-up on therapeutic requirements and treatment monitoring. After therapy, return to the routine NG14 schedule or an SSMDT-agreed personalised plan. |
| Unresectable stage III / stage IV | Personalised, treatment-led follow-up based on systemic therapy, disease activity, symptoms, palliative-care needs and SSMDT plan. |
Whole-body CE-CT routinely includes thorax, abdomen and pelvis; include neck or other sites when clinically indicated. Use whole-body and brain MRI instead of CE-CT for children / young adults under 25 and pregnant patients having imaging. Use brain MRI for known or resected brain metastases. Do not routinely use PET-CT during melanoma follow-up.
cSCC — BAD 2020 (three-tier risk stratification)
BAD follow-up is risk-tiered and includes examination of the scar, full skin and relevant lymph-node basins, plus education on skin and nodal self-examination. Risk status should be documented after histology and MDT review where indicated.
| Risk tier | Typical features | Schedule |
|---|---|---|
| Low-risk | BWH T1, well-differentiated, completely excised, immunocompetent, no PNI / LVI, low-risk anatomy | Single post-treatment appointment where appropriate to check histology, examine skin and nodes, provide education and safety-netting; then discharge. |
| High-risk | Moderate–poor differentiation, depth into subcutis, small-calibre PNI, immunocompromised, anatomically high-risk site (lip, ear), or recurrent | 4-monthly for 12 months, then 6-monthly for a further 12 months; discharge at 2 years if stable and no overriding risk of further high-risk primaries. |
| Very high-risk | BWH T2b / T3, named-nerve PNI, ≥ 2 BWH risk factors, bone invasion, recurrent disease with high-risk features, OTR with prior cSCC. Regional nodal, in-transit or distant disease should use the metastatic cSCC schedule. | 4-monthly for 24 months, then 6-monthly for a further 12 months; discharge at 3 years if stable. Patients at high risk of further high-risk primary cSCC, including many OTRs, should remain under lifelong skin surveillance. |
| Metastatic cSCC | Regional nodal disease, in-transit disease or distant metastatic disease after treatment with curative or disease-controlling intent | 3-monthly for 24 months, then 6-monthly for a further 36 months; consider longer-term review depending on patient and tumour factors. Imaging is based on clinical findings and SSMDT discussion. |
Do not routinely image the draining nodal basin when there is no suspected or clinically detectable nodal disease. Consider high-resolution nodal ultrasound for selected very high-risk clinically N0 lesions, such as pT2 or greater lip cSCC. Sun-protection counselling, skin self-examination education and red-flag instructions should be reinforced at every visit.
BCC — BAD 2021
| Risk tier | Typical features | Schedule |
|---|---|---|
| Adequately treated isolated BCC | Single BCC treated with adequate clinical and histological clearance; especially primary, well-defined, nodular / superficial BCC without high-risk features | No routine follow-up after adequate treatment, except a postoperative review where appropriate. Discharge with written histology result, skin self-examination advice and primary-care / patient-initiated re-access instructions. |
| High-risk BCC with residual recurrence concern | Morphoeic, infiltrative, micronodular, basosquamous; area L > 20 mm, area M > 10 mm or any area H lesion; poorly defined; recurrent; immunosuppression; prior radiotherapy site; PNI; deep invasion; close / involved margin | Discuss close or involved high-risk margins at MDT. If observation, nonsurgical management or conservative monitoring is chosen, follow-up may be justified: 6-monthly for the first year, then annually for at least 5 years; consider up to 10 years or longer for selected high-risk patients. |
| Multiple BCCs / syndromic / advanced BCC | Multiple primary BCCs likely to recur or develop further tumours within 12 months; Gorlin syndrome; immunosuppression; locally advanced or metastatic BCC | At least yearly follow-up for adults with multiple BCCs likely to develop further tumours or recurrence within 12 months. Advanced BCC follow-up should be SSMDT-led and case-by-case. Gorlin and selected immunosuppressed patients usually need lifelong dermatology surveillance. |
Merkel cell carcinoma — ESMO-EURACAN 2024
After radical treatment, follow-up examinations are recommended every 3-6 months for the first 3 years, then every 6 months until year 5. After 5 years, continue annual lifelong general physical examination including complete skin check. Each review should include total-body skin examination, scar / in-transit field assessment and lymph-node examination. Routine cross-sectional imaging may be proposed for higher-risk patients; otherwise imaging is symptom- and MDT-led.
Cutaneous lymphoma — shared with supraregional CTCL service
Long-term follow-up is shared between the local dermatology service and the UK supraregional CTCL service. Cadence is stage-stratified by ISCL/EORTC TNMB and adjusted by treatment phase — more intensive in active disease, less frequent in stable indolent stages. Maintenance phototherapy, topical regimens and patient education on red-flag symptoms (new plaques, tumours, erythroderma, lymphadenopathy). Specific cadence per local supraregional CTCL service protocol.
OTR / immunosuppressed — intensive surveillance
There is no single UK cadence that applies to every OTR. As a minimum, kidney-transplant guidance supports annual skin surveillance by a healthcare professional, and OTRs with precancerous or cancerous lesions should be reviewed in a dedicated transplant-dermatology pathway where available. Escalate frequency according to tumour burden: use the BAD cSCC high-risk / very high-risk schedules after cSCC, and keep OTRs at high risk of further high-risk primary cSCC under lifelong skin surveillance. Coordinate with the transplant team for immunosuppression review (CNI → mTOR conversion per TUMORAPA / CONVERT / RESCUE evidence base, acitretin chemoprophylaxis, voriconazole avoidance / switch where antifungal cover still indicated).
Skin self-examination — what to teach the patient
- Monthly full-body skin self-examination — mirror + partner / family for posterior aspects
- What to look for: new lesion, changing lesion (ABCDE for pigmented; new symptoms — itch, bleed, sensation change — for non-pigmented), non-healing wound > 4 weeks, new lump near a previous scar, new lump in the regional nodes
- Photography of stable lesions for comparison (smartphone photograph with a coin / ruler for scale)
- What to do: contact the local skin-cancer specialist nurse helpline OR re-refer via GP — emphasis on the helpline as the fastest route
- Sun-protection counselling: SPF 50+ broad spectrum daily; UV-protective clothing including hat; avoidance of midday sun; vitamin D supplementation
Recurrence triage
Any clinical suspicion of locoregional or distant recurrence prompts:
- Urgent re-staging — re-image per the original staging protocol (CT TAP / MRI brain for melanoma; MRI head/neck for cSCC with PNI; PET-CT for MCC).
- Biopsy of any new lesion clinically suspicious — even seemingly trivial papules over the surgical site or in a previous radiation field.
- Urgent re-presentation at SSMDT.
- Consideration of systemic therapy escalation (TA802 cemiplimab for advanced cSCC; ipi/nivo for metastatic melanoma).
Late effects of treatment
Surgical late effects
Scar maturation (12–18 months), hypertrophic / keloid scarring (consider intralesional triamcinolone, silicone gel, pressure therapy), lymphoedema after nodal dissection (12-week onset typically; lymphoedema clinic referral), donor-site morbidity, marginal mandibular branch dysfunction after cervicofacial / parotid surgery.
Radiotherapy late effects
Telangiectasia, fibrosis, hypo- or hyperpigmentation, alopecia in hair-bearing areas, atrophy, late ulceration / necrosis (rare with modern fractionation), late lymphoedema, and the risk of radiation-induced second malignancy (BCC, cSCC, AFX, PDS, angiosarcoma — Stewart-Treves variant arising in chronic lymphoedema). Long-term skin surveillance is essential.
ICI late effects
Most irAEs declare within months of starting ICI but can present up to a year after the last dose. Endocrine irAEs (thyroiditis, hypophysitis, T1DM, primary adrenal insufficiency) often require lifelong hormone replacement. Patient education on stress-dose steroids in adrenal insufficiency; medical-alert bracelet for hypophysitis patients. 24/7 acute oncology helpline.
BRAF/MEK late effects
Cutaneous secondary tumours (cSCC, keratoacanthoma — paradoxical RAS pathway activation), pyrexia (dabrafenib + trametinib characteristic), photosensitivity (vemurafenib), retinopathy (MEK inhibitors — annual ophthalmology review).
Psychosocial support
Skin cancer diagnosis carries a substantial psychological load — body image after facial reconstruction, fear of recurrence, scanxiety. Skin-cancer specialist nurses are the central support resource. Charity links: Melanoma UK, Skcin, Macmillan, Cancer Research UK. Routine FFT and qualitative feedback at each follow-up visit. Refer for formal psychological support where indicated.
When to discharge
Published schedules have different discharge points: melanoma stage IA at 1 year; melanoma stages IB to resected IV usually at 5 years; high-risk cSCC at 2 years; very high-risk cSCC at 3 years; metastatic cSCC after 5 years with longer review when needed; single adequately treated BCC after postoperative review; MCC continues annual lifelong review after year 5. At discharge:
- Discharge letter to the GP summarising the diagnosis, treatment, current status, and red-flag advice for the patient.
- Re-referral instructions for the patient — clearly written, contact details for the skin-cancer specialist nurse helpline.
- Final patient education on long-term sun protection and full-body self-examination.
- For unresectable melanoma, active systemic therapy, OTRs with ongoing high-risk tumour burden, Gorlin syndrome, multiple BCCs and higher-risk MCC: ongoing or indefinite follow-up may be appropriate; discuss at MDT before discharge.
End-of-life pathway
For patients with advanced disease who have exhausted curative-intent options:
- Multidisciplinary discussion with palliative care (early integration, not only at end of life).
- Advance care planning — ReSPECT form, preferred place of care, treatment escalation discussions.
- Symptom control — pain (often neuropathic ± nociceptive), lymphoedema, in-transit ulcerated cutaneous deposits (electrochemotherapy IPG446 in selected cases, palliative RT, dressings, charcoal odour-control dressings).
- Psychological support for patient and family.
- Community hospice involvement.