Melanoma

Melanoma

A patient guide to examining your skin and lymph nodes following treatment for melanoma

What are the aims of this leaflet?
This leaflet has been written to give you information about your aftercare following treatment for a melanoma. We hope it will help you to understand more about why you should be examining yourself and what to do if you are worried. It will help you to support the discussion that you have had with your Consultant and Clinical Nurse Specialist.

Why should you be checking your lymph glands?
You have been diagnosed with a skin cancer that has a risk of spreading to other parts of the body that is why we strongly encourage regular and thorough self-examination of your scar, skin and lymph glands. This practice will help you to identify and report any abnormalities early. If you want to know more about the chances of your melanoma returning talk to your Consultant or Clinical Nurse Specialist.

Your Consultant or Clinical Nurse Specialist will show you how to examine your scar, skin and lymph glands and what to do if you think something is different. 

Should I be reporting any other symptoms?
Sometimes if your melanoma has spread to another part of your body you might notice changes in your overall health or the presence of new symptoms. These may include

• Liver – Loss of appetite or unexplained weight loss
• Bone – Bone pain or unusual fractures
• Lungs – A persistent unexplained cough or shortness of breath
• Brain – Headaches or seizures
• Lymph nodes – Enlarged lymph node

Please inform your General Practitioner (GP) or Clinical Nurse Specialist so that you can be seen quickly. The symptoms could also be related to something else but we would like to know.

Follow up care
In most cases, melanoma recurrence is self-detected. However, we will need to see you again after the completion of your wide local excision for regular follow up.  These are arranged to undertake a more comprehensive assessment for recurrence should it occur and surveillance of new lesions of concern, support and education. We will check the following:

• The scar
• The surrounding skin
• The regional lymph glands and
• a general examination will be performed

We will teach you how and where to feel and what to look for. This is usually done at your first follow up appointment in the outpatient’s department. Undertaking regular self-examination is just as important as attending your appointments for check-ups. Please let us know if you have not received your follow up appointment within the time scale advised by your Consultant or Clinical Nurse Specialist on:

01905 733876

Looking after yourself

Examining your skin
Lumps can reoccur at the original site (scar) of the melanoma in the form of a lump within or under the skin. The lump can often look the same colour as the surrounding skin or occasionally it is blue, black or red. Any recurrence will feel different from the surrounding skin; it often feels like a dried pea, marble, or a hard, smooth, round lump which is usually painless.

We will ask you to carefully check your skin (by looking and feeling):

• Your scar and surrounding skin
• The skin between the scar and nearest lymph glands
• The lymph glands themselves, especially those nearest your scar
• A general skin check from head to toe, for any new growth or sore that will not heal, any new or changing moles that have changed in size, shape or colour, or which begin to bleed or scab or any unusual marks. Something growing under your nail or a new pigmented (darker or coloured) line in the nail.

You will need to make sure you have plenty of light when carrying out your skin check. Use a full-length mirror and a small hand-held mirror for areas that are hard to reach. You can ask a partner, relative or friend to look at your back and parts of your skin that are hard to see.

It can often be helpful to take a set of baseline photographs of your moles to aid future self-examination and assist your medical team make informed decisions about them.  If you need any further help or advice about self-examination you can discuss this with your Clinical Nurse Specialist on 01905 733876

We want you to seek advice about anything that is new or changing or looks odd.

Examining your lymph nodes
If the skin cancer returns it can spread to other parts of the body through the blood and lymphatic system. The lymph nodes are glands and are part of the lymphatic system which is both a fluid drainage system and part of the immune system. The lymphatic system is made up of fine tubes called lymphatic vessels. These tubes connect to groups of lymph nodes throughout the body. These act as a first line of defence against infection and in defending against cancer.

When you have an infection, lymph nodes often become enlarged and tender. They also become enlarged if melanoma spreads to them. If you are very slim, you can feel the glands particularly in the groins. They are usually garden pea sized and firm if they are healthy.

The aim of self-examination is to detect changes/enlargement of the lymph nodes you could feel before or newly appearing glands. Remember, if your melanoma has returned it can often be cured if it is found at an early stage.

Diagram 1: Position of lymph nodes

How often should I examine myself?
Checking your lymph nodes every two weeks is ideal and this can be done at the same time as you check your skin and your scar. Checking them more often may result in difficulty in noticing any change and can increase your anxiety.

What should I check?
In this order, use a firm pressure rolling the skin over the underlying muscle.  This action makes it easier to feel for lumps. Use the same method to check the skin between the scar and the lymph nodes and the lymph nodes themselves.

There are four areas that need to be particularly carefully checked:

• The scar at the original site of the melanoma
• The skin around this area
• The skin between the scar and nearest lymph glands (nodes)
• And the lymph glands (nodes) themselves. The lymph glands are present in the groin, armpits, above the collar bones and the neck. Both sides (armpits, groins and neck) should be checked

Site of melanoma and lymph node group to check?

Site of Melanoma	Lymph node group to check
Leg	Behind knees, groins
Chest, back, abdomen	Both groins, armpits, above both collar bones, neck
Arm	Armpits, above both collar bones, lower neck
Head and neck	Side of the neck, under chin, above collar bones, behind ears, back of neck

How do I check lymph nodes in the head and neck?
Examine in the order shown, starting at no. 1.

Diagram 2: sideways view showing lymph nodes

• With your fingertips and a gentle circular motion feel the lymph nodes illustrated
• Start with the nodes in front of the ear (no. 1 in diagram 2) then follow in order finishing just above the collar bone (no. 10 in diagram 2)
• Always check your nodes in this order
• Check both sides for comparison. If you have an enlarged lymph node it may feel firm and the size of a pea, sometimes it can be larger.

Diagram 3: Checking your lymph nodes in front of the ear.

Diagram 4: Checking your lymph nodes in the neck

When feeling for the nodes in the neck (no 8. In diagram 2):

• Tilt your head towards the side you are examining, this helps to relax the muscle
• Now press your fingers under the muscle

Diagram 5: When checking the lymph nodes above the collar bone:

• Hunch your shoulders and bring your elbows forward to relax the skin
• Now feel the area illustrated in Diagram 5

How to check lymph nodes in the armpit
Diagram 6. Checking your lymph nodes in the armpit; location of lymph nodes in the armpit.

Remove top clothing down to the waist to get easy access to the armpits:

• Sit in a comfortable position
• Check each armpit in turn

To check the left side, lift your arm slightly then place the fingers of your right hand high into the armpit and then lower your arm.

• Feel in the central area of the armpit

Now move your fingers firmly against the chest wall as follows:

• Along the front border of the armpit
• Along the back border of the armpit
• Feel along the inner border of the arm

Now check the other armpit in the same way.

How do I check lymph nodes in the groin? 
Diagram 7: Checking your lymph nodes in the groin

• There are two areas to look for inguinal (groin) nodes (see Diagram 7)
• Feel the horizontal chain of nodes in the right groin just below the ligament (see diagram 7)
• Feel the vertical chain along the upper thigh (see diagram 7)
• Check the lymph nodes in the other groin

What should I do if I am worried?
Don’t worry at home – get it checked. You can telephone your Clinical Nurse Specialist and we will arrange an appointment for you to be seen in clinic promptly. Contact your Clinical Nurse Specialist on 01905 733876. Occasionally you may be asked to see your GP for review rather than coming to the hospital.

Self-examination will be an important practice to continue lifelong.  It is advised that you let any healthcare professional looking after you that you have had a melanoma.

About this information
This leaflet is aimed at providing you with advice and general information; it does not replace professional medical advice. Some of the information used has been adapted from the Wessex Trust Cancer leaflet; How to check your lymph nodes which has been assessed for readability by the British Association of Dermatologists patient information lay review panel.

Local sources of further information
You can visit any of the Macmillan Cancer Information and Support Centres listed below:

Worcestershire Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD
Telephone: 01905 733837

Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB
Telephone: 01527 503030, Ext 44238

Kidderminster Hospital & Treatment Centre, Bewdley Road, Kidderminster, DY11 6RJ
Telephone: 01562 513273

National Source of Information
British Association of Dermatologists
www.bad.org.uk

Skin Oncology Clinical Nurse Specialist Team
Based at Worcestershire Royal Hospital, Dermatology, Redwood Suite, Level 2, Worcester, WR5 1DD. Telephone contact : 01905 733876

A patient guide to examining your skin and lymph nodes following treatment for melanoma
Owner : Wendy Bramhall, Macmillan Skin Oncology Clinical Nurse Specialist

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Thursday from  8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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