No universal level for post-melanoma monitoring

Dear Dr. Roach: My husband developed melanoma, and had 16 lymph nodes removed. He was considered a cancer survivor. He went for skin checkups twice a year and was given an OK. He died two months ago from tumors on his liver, lungs and brain. He was stage 4 by the time we knew the cancer was back. Is there some test we could have had to know earlier? — K.D.

Dear K.D.: Malignant melanoma is a common cancer. Most people with melanoma that has been caught early can expect to be cured, but when even a single lymph node is positive, the situation is more serious. Ninety-three percent of people will survive five years, and 88% for 10 years.

There is no universally accepted answer for how to monitor people with melanoma and a positive lymph node, but most experts do skin checkups. There is no definitive evidence that additional testing would have been of benefit. Treatment for melanoma is dramatically improving, but still not perfect.

About 10% of melanomas are thought to be familial. People with a strong family history should have a regular skin exam. Prevention is important for everyone.

Everyone should know how to identify the worrisome appearance of a melanoma:

A for asymmetry, meaning one side is different.

B for border irregularities. C for color differences within the lesion.

D for a diameter greater than 6 mm (a pencil eraser).

E for enlargement or evolution of color, change, shape or symptoms.

Any new darkly colored skin lesion that looks different from the others a person has should be evaluated.

Dr. Keith Roach