Questions to Ask About Melanoma
For someone just diagnosed with melanoma, and for the relative going with them, to take to the dermatologist, surgeon or oncologist. The 51 questions follow the order things tend to happen in: reading the biopsy report, lymph nodes and other checks, surgery, any further treatment, the outlook and follow-up, then sun protection and what it means for family. Each has a note on what a clear or a worrying answer sounds like or what to do with it, and none of it is medical advice.
The questions
Each question, and why to ask it
The biopsy report
What type of melanoma is this, and is it invasive or in situ?
Why ask it
In situ means the abnormal cells are still in the top layer of the skin, and invasive means they have grown below it, so the two lead to very different conversations. Have the doctor point to the line on the report that says which, and write the subtype down so you can spell it later.
How thick is the melanoma, in millimeters?
Why ask it
The report usually calls this the Breslow thickness or depth, and most of the later decisions lean on it. Copy the number exactly, decimal included, then find out which side of any cut-off for further tests it puts you on.
What stage does this make it, and what still has to be checked before that is final?
Why ask it
After a biopsy alone the stage is often a working one, because nobody has looked at the lymph nodes yet. Get the full stage with its letter, not only the number, and hear which result could move it up or down.
Did the biopsy take all of it, or was melanoma left at the edges?
Why ask it
A biopsy is done to diagnose, so it is not unusual for melanoma to reach the edge of the sample, and that alone does not mean anything went wrong. The point to settle is whether the deepest part was cut through, because then the thickness on the report may be an underestimate.
Was the melanoma ulcerated, and how fast were the cells dividing?
Why ask it
On the report these are 'ulceration' and 'mitotic rate', and they tend to go by without a word of explanation. A clear answer says what yours showed and whether either one changes the stage or the plan. If the doctor has to look it up, wait while they do.
Did a dermatopathologist read my slides, and would a second read be worth having?
Why ask it
Telling an odd mole from an early melanoma and measuring its depth are judgment calls, and many referral centers reread outside biopsies as routine. 'We already do that' is a good answer. Wording such as 'atypical' or 'cannot exclude' on your report is a reason to press for the second look.
Can we go through the pathology report line by line, and may I keep a copy?
Why ask it
Every line is either a finding or a 'not identified', so have each one translated and mark the two or three that drive the plan. A second opinion, a new dermatologist in ten years or a relative's doctor will all want that copy. How you get it differs by clinic, so ask how it works there.
Does where it was on my body change how it is treated?
Why ask it
A melanoma on the scalp, face, hand, foot, under a nail or on a moist lining such as the mouth may be operated on differently from one on the back or leg, sometimes by a different kind of surgeon. If yours is in one of those places, find out who has the most practice with that site.
Has the melanoma been tested for a BRAF mutation or other markers, or is it too early for that?
Why ask it
For a thin melanoma, 'not needed' is a common and reasonable reply. Where the melanoma has reached the nodes or beyond, the result is one of the things an oncologist looks at when choosing a drug, so check whether the sample has gone to the lab and who will tell you what it showed.
Lymph nodes and other checks
Is there any sign the melanoma has spread, and how would you know?
Why ask it
At this point the answer usually rests on three things: the thickness on the report, what the doctor can feel in the nodes nearest the melanoma (sometimes with an ultrasound as well), and any symptoms you mention. Hear which group of nodes drains your site and what was found there today. 'No sign so far' and 'checked and clear' are different statements, so pin down which one you were given.
Would you recommend a sentinel lymph node biopsy for me, and why or why not?
Why ask it
This is a small operation to take out the first node or nodes the melanoma would drain to, and whether it is offered follows cut-offs that guidelines set and revise. It is usually planned for the same operation as the wider excision, so raise it before that surgery is booked, not after.
What would a positive sentinel node change, and what would a negative one tell me?
Why ask it
Putting it this way shows whether the procedure is worth having in your case. If a positive result would open up drug treatment or closer scanning that you would want, there is your reason. If neither result would alter what happens next, say so and ask what you gain.
What are the risks of a node biopsy, including lasting swelling in the arm or leg?
Why ask it
Lymphedema, a pocket of fluid at the site, numbness and infection are the ones usually named. The groin, armpit and neck each carry different odds, so ask about the area that applies to you and what early swelling looks like.
Do I need any scans or blood tests now, and what would they be looking for?
Why ask it
For an early melanoma the answer is often no, and that is not a sign of being under-treated: a scan in a low-risk case can turn up harmless findings that then have to be chased. If scans are ordered, the details to get are which parts of the body, and when and how you will hear.
Have you looked over the rest of my skin, scalp and nails, and is there anything else you want to remove or watch?
Why ask it
Someone who has had one melanoma is watched for another, so a head-to-toe exam around the time of diagnosis is common practice. If nobody has parted your hair, checked between your toes and looked at your back, ask for that to be booked before the surgery date.
Surgery
What is the plan from here, and is surgery the first step?
Why ask it
Ask for the sequence as a list: the operation, any node biopsy, when each result comes back, and the point at which further treatment gets decided. If something comes before surgery, such as a scan or a team meeting, hear why. Being able to repeat the plan in order is the test of whether it was explained.
How wide and how deep will the excision be, and what decides that?
Why ask it
A wide local excision takes a border of normal-looking skin around the biopsy site, and the width follows from the thickness on your report. Get the margin in centimeters, then have the surgeon draw the outline on you. It will be longer than you expect, because the cut is a long oval that closes flat.
Who should do this operation: a dermatologist, a plastic or general surgeon, or a surgical oncologist?
Why ask it
Depth, location and whether nodes are sampled the same day all bear on it. A good reply explains why this person suits your case and how often they operate on melanoma. With a node biopsy planned, check that both parts happen in one sitting.
Should I get a second opinion on the plan before surgery, and will you send my records if I do?
Why ask it
It earns its place when the plan includes a node biopsy or drug treatment, when the melanoma is somewhere awkward, or when the clinic sees few melanomas a year. A doctor who is sure of the plan tends to say yes without fuss. Check how long a referral takes where you are, so it fits inside the wait the surgeon calls safe.
How soon should the surgery happen, and is it safe to wait a few weeks?
Why ask it
People picture the melanoma spreading by the day, and the surgeon's answer is often calmer than that. A window given in weeks lets you arrange time off, child care or a second opinion without guilt. If you hear 'as soon as we can book it', ask what date that means.
Will I be awake with the area numbed or asleep, and will I go home the same day?
Why ask it
A wide excision on its own is often done with local anesthetic, and adding a node biopsy tends to change that. The answer settles whether you need a driver, whether you fast, and which of your regular medicines to ask about beforehand.
Will the wound close in a straight line, or might I need a skin graft or a flap?
Why ask it
On the shin, scalp, face, hand or foot there may not be enough loose skin to bring the edges together. If a graft is possible, the next thing to know is where the donor skin would come from, since that is a second wound to care for, and whether a plastic surgeon would do the repair.
What will the scar be like, and will it affect how I move or use that part of my body?
Why ask it
Have the surgeon show you where the line will run and how long it will be. Over a joint, on the sole of the foot or near an eye, function matters as much as looks: when you can walk on it, bend it, or wear your usual shoes.
What does recovery involve, and when can I work, drive, exercise and swim again?
Why ask it
Name your actual job and your actual sport, since a desk and a building site get different answers. Leave with the wound care in writing and a date for the stitches to come out, plus who takes them out.
When will the pathology from the surgery be ready, and what happens if the margins are not clear?
Why ask it
The skin that is removed gets examined too, and now and then the report asks for more to be taken. Hearing about that possibility in advance makes a second operation a known step instead of a shock. Check how the result reaches you: a call, a portal, or the stitch-removal visit.
Is Mohs surgery or a staged excision an option for where mine is?
Why ask it
For melanoma in situ on the face, ears or scalp, some surgeons use techniques that check the edges before closing and spare more skin, while a standard wide excision is the usual plan for most invasive melanomas. Worth asking if you have read about Mohs for other skin cancers and wondered why it was not mentioned.
Further treatment
After surgery, will I need any other treatment, or is the operation expected to be all of it?
Why ask it
For many early melanomas the operation is the whole treatment, and it helps to hear that said out loud. If the reply is 'it depends on the nodes', get each result mapped to what would follow, so the options are not new to you on results day.
Would immunotherapy or targeted therapy be offered in my case, and what is it meant to do?
Why ask it
These drugs are given to lower the chance of a higher-risk melanoma returning, or to treat one that has spread. Find out which drug, how it is given and for how long, and how much it is expected to help at your stage, put as so many people out of a hundred.
What are the side effects of that drug treatment, and which ones can be permanent?
Why ask it
Immunotherapy does not behave like the chemotherapy most people picture: its side effects come from the immune system turning on healthy organs, and some, such as thyroid and other hormone problems, can last. You want the common and manageable separated from the rare and lasting, plus the symptoms to report the same day.
Should I see a medical oncologist, and will a melanoma team discuss my case?
Why ask it
With a thin melanoma, a dermatologist and a surgeon may be everyone you need. Once nodes are involved, 'yes, and here is the referral' is the reply to hope for. A doctor who sees no need should be able to say at what stage they would send you.
Do my other conditions or medicines, such as an autoimmune disease or a blood thinner, change any of this?
Why ask it
Immunotherapy works by taking the brakes off the immune system, so an autoimmune disease, a transplant or long-term steroids can complicate it, and blood thinners matter for the surgery. Bring the full medicine list, and find out who will speak to the doctor who prescribes each one.
Is radiation ever part of treating a melanoma like mine?
Why ask it
Usually a short answer, and often no. Asking once means that if radiation comes up later, for a node area or an awkward site, you will know whether it was always a possibility or a change of plan.
Are there clinical trials I should hear about before any treatment starts?
Why ask it
Some trials only take people who have not yet had surgery or a first dose of a drug, which is why the timing matters. 'Not at this hospital' is half an answer, so follow up with where the nearest melanoma center running trials is and whether they would refer you.
What will all of this cost me, and who can check my coverage before I agree to a date?
Why ask it
The excision, the lab work, a node biopsy, scans and drug treatment can each be billed or funded separately, and what you pay depends on your country, insurer and hospital. Get the name of the person at the clinic who handles this before anything is booked.
Outlook and follow-up
What is the outlook at my stage, and what in my report makes my case better or worse than the average?
Why ask it
Decide beforehand whether you want figures and say so, because most doctors follow the patient's lead on this. The figures describe large groups treated some years ago. The useful part is which of your own findings, such as thickness, ulceration or the nodes, pull you one way or the other.
What is the chance of it coming back, and where would it be most likely to show up?
Why ask it
A melanoma can return at the scar, in the skin between the scar and the nearest nodes, in those nodes, or further away, and each is found in a different way. Knowing where to look is easier to use than a percentage. Ask as well how the risk changes as the years go by.
How likely am I to get a second, separate melanoma?
Why ask it
People merge this with recurrence, and it is a different thing: a brand new melanoma somewhere else on the skin. It is a large part of why skin checks carry on for years. The follow-up is whether your number of moles, your skin type or your family history puts you above the usual risk.
How often will I have skin checks, for how many years, and with whom?
Why ask it
Visits tend to be closer together at first and then spaced out, but the intervals differ between guidelines and countries, so have yours written down. Pin down who does each one. When a dermatologist, a surgeon and a family doctor are all involved, each can assume another is watching.
Will follow-up include scans or blood tests, or only examinations?
Why ask it
At early stages it is often examination alone, and at higher stages some teams add node ultrasound or body scans at set intervals. Either way, learn what happens after an unclear scan result, because those are not rare and can mean weeks of waiting.
Can you show me how to check my own skin and lymph nodes, and how often I should do it?
Why ask it
Have them place your fingers on the nodes nearest your scar so you learn what normal feels like. Many people are told once a month, but take the interval your own doctor gives. For the back and scalp you need a partner, two mirrors or a phone camera.
Should I have photographs or mole mapping so that changes are easier to spot?
Why ask it
With a lot of moles, memory is a poor record of what was there last year. Whether total body photography or digital mole monitoring is offered, and whether it costs extra, varies from clinic to clinic. Where it is not available, offer your own dated phone photos and see whether the doctor would use them.
Which changes should bring me back before my next appointment, and how do I get seen quickly?
Why ask it
Expect a list: a new or changing mole, a spot unlike your others, a lump under the skin near the scar, a swollen node, a symptom that will not clear. The second half matters more. Does a past melanoma let you call the clinic directly, or do you need a fresh referral each time?
Who can I talk to about the worry, especially in the days before a check-up?
Why ask it
Dread before a skin check or a scan is very common after melanoma, and it can be strong even when the melanoma was thin. Push past 'there is support available' to a person: a specialist nurse, a counselor or a patient organization the clinic trusts, with a number you can use that week.
Sun and family
Do you know what led to this: sun, old sunburns, tanning beds, my skin type, or chance?
Why ask it
Many people carry blame about childhood burns or years without sunscreen. A doctor can usually say which risk factors you have and cannot say which one did it. Use the answer to decide what to change and what to tell relatives, not to audit the past.
What sun protection do you want me to use from now on, and does it change in winter or on cloudy days?
Why ask it
Hold out for a routine and not a slogan: which SPF, how much, how often, and what clothing and hat for your work and hobbies. A doctor who asks what you do outdoors before answering is building a plan you will keep.
Can I still work, exercise and vacation outdoors, and what should I do differently?
Why ask it
The usual reply is yes with changes, not a life spent indoors. Name the real thing, whether that is the garden, the golf, the roofing job or the beach week, and get advice on timing, shade and clothing for it. For an outdoor job, a letter to your employer may be worth requesting.
Is any kind of tanning still acceptable, including tanning beds or a 'base tan' before a trip?
Why ask it
Be ready for a firm no, and it is worth hearing from your own doctor because friends and salons may say otherwise. If you have used tanning beds, say so plainly. It belongs in your history and nobody in the room is keeping score.
If I am staying out of the sun, do I need to take vitamin D?
Why ask it
A common worry once the hats and long sleeves come out. The reply might be a blood test, a supplement or nothing at all, depending on your diet, your skin and where you live, so get a dose from the doctor instead of guessing at one.
Does my melanoma raise the risk for my children, siblings or parents, and what should I tell them?
Why ask it
Leave with a sentence you can pass on: who should have their skin looked at, from what age, and how often. Then send relatives the diagnosis in writing, with the type and the year, because their own doctors will ask for exactly that.
Is there anything in my history that points to an inherited risk, and would you refer me to a genetic counselor?
Why ask it
Doctors listen for several relatives with melanoma, more than one melanoma in the same person, a diagnosis at a young age, or pancreatic cancer in the family. Bring what you know, gaps included. Most melanoma is not inherited, so do not read 'no referral needed' as being brushed off.
How should I protect my children's skin, and should anyone be looking at their moles?
Why ask it
Parents often leave with a plan for themselves and none for their kids. Cover sunscreen, clothing and shade by age, and whether a child with many moles or very fair skin should be seen. Routine skin checks for children are not standard everywhere, so ask what is done where you live.
Getting through the first melanoma appointments
Practical guidance for the conversation itself
Before the appointment
Get the pathology report in your hands first
Ask the clinic for a copy of the biopsy report before the visit, by portal, email or on paper, whichever way they release it. Circle the thickness, the word 'ulceration', the margins and any stage. You will not understand all of it, and that is fine: the circled lines are your first questions.
Match the questions to the doctor
A dermatologist can usually answer the groups on the biopsy report, skin checks and sun. The surgeon owns the excision and the node biopsy, and a medical oncologist owns drug treatment. Mark five or six questions for whoever you are seeing this time and park the rest for the right person.
Write down your skin history
Note bad sunburns you remember, any tanning bed use, earlier biopsies and what they showed, and relatives with melanoma or other cancers with rough ages. Add every medicine you take, especially steroids, drugs that suppress the immune system and blood thinners. It saves the doctor asking one item at a time.
Photograph the site and the moles you worry about
Before surgery, take a clear photo of the biopsy site and of any other mole you want looked at, with a coin or ruler beside it for scale and the date in the file name. After the excision the original spot is gone, and a later doctor may want to see what it looked like.
In the room
Give your companion the numbers
If someone comes with you, their job is to write down figures and dates: thickness in millimeters, the stage with its letter, the planned margin, when results are due and who calls whom. You listen and ask. Two people both trying to listen leave with nothing on paper.
Say how much you want to hear about outlook
Some people want survival figures at the first visit and some never do. Tell the doctor which you are before the subject comes up, and say if your companion wants a different amount than you. You can change your mind at a later appointment.
Ask for the plain word after the medical one
Melanoma talk is full of terms that sound alike: in situ and invasive, margin and stage, recurrence and a new primary, sentinel node and node dissection. Each time one goes past, ask what it means for you, and write the answer next to the term.
Read the plan back before you stand up
Finish with one sentence of your own: what is being done, by whom, on roughly what date, when the result arrives and which number you call if it does not. If the doctor corrects any part of it, you have just avoided a week of confusion.
Between appointments and afterward
Keep one folder
Put every pathology report, the operation note, scan reports, photos and the follow-up schedule in one place, paper or digital. Melanoma follow-up runs for years and often across several clinics, and you are the only person certain to be at every visit.
Put the skin checks in your own calendar
Enter each follow-up date yourself and set a reminder a few weeks ahead to confirm it is booked. Clinic reminder systems vary, and they tend to lose people who move house, change insurer or change doctor. Add a repeating reminder for your own skin check at home too.
Be careful what you read
Melanoma treatment has changed a great deal in recent years, so an old article or forum post may describe options and outcomes that no longer apply. Ask your doctor which organizations they would send a patient to, check the date on anything you read, and bring what worries you to the next visit.
Tell your relatives once, in writing
A short message to parents, siblings and adult children with the diagnosis, the year and what your doctor suggested for family members does more than a phone call they half remember. They can show it to their own doctor, who decides what it means for them.
Mistakes to avoid
Leaving without the thickness and the stage
These two facts shape nearly everything else, and people regularly go home knowing only that 'it was melanoma'. If you have neither written down by the end of the visit, ask again before you leave the building.
Assuming the worst, or assuming it is nothing
Melanoma covers a very wide range, from a spot removed in one small operation to a cancer that needs a full team. Both 'it is only skin cancer' and 'this is the deadly one' skip the question that matters, which is where yours sits. Let the report and the doctor answer that.
Comparing with someone else's melanoma
A neighbor's story or a stranger's post comes from a different thickness, a different stage and often a different decade of treatment. When a comparison is bothering you, take it to the doctor as a question: 'A friend had a node biopsy and I am not having one. Why is that?'
Letting follow-up lapse once the scar has healed
The first year of checks is easy to keep. The fourth is not, especially after a move or a change of doctor. If you fall off the schedule, call and say you have a history of melanoma and are overdue; do not wait for a new spot to give you a reason.
Agreeing to everything in the room
Unless the doctor tells you a decision is urgent, you can take the plan home, read it, and call back with questions or ask for a second opinion. Ask how long the decision can safely wait, so that taking a few days is a choice and not a risk.