For most people, the cancer experience doesn't end on the last day of treatment. Life after cancer treatment can present its own challenges.
You may have mixed feelings when treatment ends, and worry that every ache and pain means the cancer is coming back.
Some people say that they feel pressure to return to "normal life".
It is important to allow yourself time to adjust to the physical and emotional changes, and establish a new daily routine at your own pace. Your family and friends may also need time to adjust.
Cancer Council 13 11 20 can help you connect with other people who have had cancer, and provide you with information about the emotional and practical aspects of living well after cancer.
See Living Well After Cancer.
Dealing with feelings of sadness
If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.
Talk to your GP, as counselling or medication – even for a short time – may help. Some people can get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council may also run a counselling program in your area.
For information about coping with depression and anxiety, call beyondblue on 1300 22 4636 or visit beyondblue.org.au. For 24-hour crisis support, call Lifeline 13 11 14 or visit lifeline.org.au.
After treatment ends, you will need regular skin checks to confirm that the melanoma hasn't come back or spread.
The follow-up plan will vary depending on the stage, and more frequent visits are recommended for people with advanced melanoma.
People who had a stage I melanoma need to see their doctor for yearly skin checks, while people with stage II melanoma will need follow-up every 6 months for several years.
People with stage III melanoma will be monitored every 3 months for two years. Your doctor can give you more details of your follow-up plan.
When a follow-up appointment or test is approaching, many people may feel anxious.
Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.
Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.
UV Index and sun protection times
The UV Index shows the intensity of the sun's UV radiation using a scale that begins at 0 and has no upper limit. An index of 3 or above indicates that UV levels are high enough to damage skin, so sun protection is recommended.
The daily sun protection times tell you the times of the day the UV Index levels are forecast to be 3 or higher. The sun protection times vary according to your location and will change throughout the year.
In general, during summer in Australia, all states experience long periods during the day when the UV Index is 3 or above. In late autumn and winter in southern Australia, the UV Index may fall below 3 and sun protection is not necessary.
Sun exposure and vitamin D
UV radiation from the sun causes skin cancer, but it is also the best source of vitamin D, which is needed to develop and maintain healthy bones.
The amount of sunlight you need for vitamin D depends on several factors, including the UV level, your skin type and your lifestyle.
UV levels vary across Australia, so the time you need to spend in the sun will be determined by your location, the season and the time of day, cloud coverage and the environment. (For more information on the UV Index, see below.)
The body can only absorb a limited amount of vitamin D at a time. Getting more sun than recommended does not increase your vitamin D levels, but it does increase your skin cancer risk.
For most people, just 15–20 minutes of incidental sun exposure, such as walking from the office to get lunch or hanging out the washing, is enough to produce the required vitamin D level.
Getting too much UV is not recommended, even for people with a vitamin D deficiency.
After a melanoma diagnosis, if you are concerned about vitamin D deficiency talk to your doctor about the best ways to maintain vitamin D while reducing your risk of further melanomas. Your doctor may recommend taking a supplement.
Protecting your skin from the sun
After a diagnosis of melanoma, you should check your skin regularly and follow SunSmart behaviour. When UV levels are 3 or above, use a combination of measures to protect your skin.
Check sun protection times every day
Check the sun protection times for your local area through the SunSmart app, online (sunsmart.com.au or bom.gov.au/uv), in the weather section of daily newspapers, or with a free website widget.
Slip on clothing
Wear clothing that covers your shoulders, neck, arms, legs and body. Choose closely woven fabric or fabric with a high ultraviolet protection factor rating (UPF).
Slop on sunscreen
Use an SPF 30+ or higher broad-spectrum sunscreen. Use a water-resistant product for sports and swimming.
Apply a generous amount of sunscreen 20 minutes before going out and reapply every two hours, or after swimming or any activity that causes you to sweat or rub it off.
Slap on a hat
Wear a broad-brimmed hat that shades your face, neck and ears. Hats for children aged under 8 years should have at least a 5 cm brim, and hats for children aged 8–12 should have at least a 6 cm brim.
Adult hats should have at least a 7.5 cm brim.
Use shade from trees, umbrellas, buildings or any type of canopy.
UV radiation is reflective and bounces off surfaces, such as concrete, water, sand and snow. If you can see the sky through the shade, even if the direct sun is blocked, the shade will not completely protect you from UV.
Slide on sunglasses
Protect your eyes with sunglasses that meet the Australian Standard AS 1067. Wraparound styles are best. Sunglasses should be worn all year round.
Use a combination of sun protection measures to protect babies and children from direct exposure to sunlight. Applying sunscreen on babies under 6 months is not recommended.
Avoid sun lamps and solariums
Do not use sun lamps, solariums or tanning beds (banned for commercial use), which give off UV radiation.
What if the melanoma returns?
In the vast majority of cases, early melanoma will not come back (recur) after treatment. The risk of the melanoma coming back after treatment is higher for people with regional melanoma.
Recurrence can occur at the site where the melanoma was removed (locally); in the lymph nodes; or further away in other body sites, like the lung, brain or liver.
People who have had one melanoma have about five times the risk of developing a new melanoma compared with the average person their age. It is important to be familiar with your skin, examine it for changes, and visit your doctor for regular check-ups.
During follow-up appointments, your doctor will examine the melanoma site and lymph nodes for any spread. Your doctor will also check the rest of your skin for other possible melanomas.
If the cancer returns, your doctor will discuss the treatment options with you. These will depend on where the cancer has recurred, as well as the stage and grade of the cancer.
You may be offered immunotherapy, targeted therapy or the option to join a clinical trial.
Expert content reviewers:
A/Prof Victoria Atkinson, Senior Staff Specialist, Princess Alexandra Hospital, Visiting Medical Oncologist, Greenslopes Private Hospital, and The University of Queensland Clinical School of Medicine, QLD; Adjunct Prof John Kelly AM, Consultant Dermatologist, Victorian Melanoma Service, and Department of Medicine at Alfred Health, Monash University, VIC; Dr Alex Chamberlain, Dermatologist, Glenferrie Dermatology, Victorian Melanoma Service and Monash Univeristy, VIC; Alison Button-Sloan, Melanoma Patients Australia; Peter Cagney, Consumer; Prof Brendon J Coventry, Associate Professor of Surgery, The University of Adelaide, Surgical Oncologist, Royal Adelaide Hospital, and Research Director, Australian Melanoma Research Foundation, SA; Dr David Gyorki, Consultant Surgical Oncologist, Peter MacCallum Cancer Centre, VIC; Liz King, Skin Cancer Prevention Manager, Cancer Council NSW; Shannon Jones, SunSmart Health Professionals Coordinator, Cancer Council Victoria; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Richard Scolyer, Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Co-Medical Director, Melanoma Institute Australia and Clinical Professor, The University of Sydney, NSW; Heather Walker, Chair, Cancer Council National Skin Cancer Committee, Cancer Council Australia.