Melanoma and Skin Cancer Recurrence
Complete remission is when there are no more signs or symptoms of cancer. Another term for complete remission is NED, which stands for No Evidence of Disease.
Remission may be permanent or temporary. When cancer returns after a period of time with NED, it is called recurrence. The cancer may recur in the same location. It may recur in a distant location, such as the lymph nodes or other organ. For this reason, regular follow up with your dermatologist is recommended after any type of skin cancer. Your doctor will probably recommend that you perform regular skin self-examinations between visits. Skin cancer survivors do not need to spend their days inside. But they should protect their skin whenever they are going to be outside.
Recurrence is different than having a second skin cancer in a different location. Having one skin cancer puts you at higher risk of having another skin cancer. Between 30% and 50% of people with a non-melanoma skin cancer develop a second non-melanoma skin cancer within 5 years.1 (The risk of melanoma is also increased.) Between 2% and 10% of melanoma survivors develop a second primary melanoma.2 Regular follow-up, skin self examination, and sun protection are important for catching or preventing second skin cancers, too.
Basal cell carcinoma recurrence
Recommended follow-up. After treatment for basal cell carcinoma (BCC), national guidelines recommend having a complete skin examination by your dermatologist every 6 to 12 months for the first 5 years.3 Recurrence may occur more than 5 years after treatment, too. Therefore, the guidelines call for yearly skin examinations for the rest of your life. Ask your doctor what she or he recommends for you.
Risk factors for recurrence. The chance of recurrence varies by type of BCC. Tumors are more likely to recur if they:3
- Are large
- Have unclear borders
- Have already recurred once
- Develop at the site of prior radiation therapy
- Surround a nerve
- Grow aggressively
People with a weakened immune system due to medications are more likely to have recurrent BCC.
Recurrence rates also vary by initial treatment. Tumors are least likely to recur after Mohs surgery. The 5-year recurrence rate after Mohs surgery is 1% for a primary BCC and 5.6% for recurrent BCC.3 Excision is also highly effective, with a 5-year recurrence rate of 2%.3
Some treatments used for thin, low-risk BCC are not appropriate when the risk of recurrence is high. This includes curettage and electrodesiccation, topical medication, cryotherapy, or photodynamic therapy. These treatments have lower cure rates.
Treatment options for recurrent BCC. A recurrent skin tumor is treated the same way as a high-risk primary tumor.3 Mohs surgery is the preferred option. Wide excision or radiation therapy are alternatives. Your doctor may recommend adjuvant therapy with radiation therapy or targeted therapy. Adjuvant therapy is an additional cancer treatment that is given after the primary (main) treatment. Adjuvant therapy can help lower the risk that the cancer comes back.
Squamous cell carcinoma recurrence
Recommended follow-up. After treatment for local squamous cell carcinoma (SCC), national guidelines recommend a complete skin examination by your dermatologist every 3 to 12 months for the first 2 years.4 The reason for this frequent follow-up schedule is that most (70% to 80%) SCC recurrences happen within 2 years.1 Follow-up should continue every 6 to 12 months for 3 more years. After that, the guidelines call for yearly skin examinations for the rest of your life.
You may need more frequent follow-up visits if the initial SCC had spread beyond the skin. Ask your doctor what she or he recommends for you.
Risk factors for recurrence. Some SCC tumors are more likely to recur than others. High-risk characteristics of BCC—listed above—are also risky for SCC. Additional risk factors for SCC are:4
- Thicker (≥2 millimeters) or more invasive tumor (Clark level IV or V).
- Tumor that has grown around a nerve, lymph vessel, or blood vessel.
- Certain SCC subtypes, which can be seen under a microscope.
- Poorly differentiated or undifferentiated cells. (Differentiation means how much the cancer cells look like the normal tissue that it came from. Poorly differentiated cells grow and spread more quickly.)
Recurrence rates also vary by initial treatment. Just like with BCC, Mohs surgery has the lowest 5-year recurrence rate (3%). It is the preferred treatment for SCC that is likely to recur.4 Excision is also highly effective, with a 5-year recurrence rate of 8%.4
Some treatments used for thin or low-risk SCC are not used when the risk of recurrence is high. These include curettage and electrodesiccation cryotherapy, photodynamic therapy, and topical medication. Because these treatments have lower cure rates, they are not appropriate for high-risk SCC.
Treatment options for recurrent SCC. A recurrent skin tumor is treated same way as a high-risk primary tumor.4 Mohs surgery is the preferred option. Wide excision, radiation therapy, and chemotherapy are alternatives. Your doctor may recommend adjuvant therapy with radiation therapy or additional surgery.
If the cancer recurs in the lymph nodes or distant organs, treatment options include surgery, radiation therapy, and chemotherapy. Treatment options for advanced SCC are limited. Your doctor may recommend participating in a clinical trial.
Recommended follow-up. Follow-up after melanoma varies by stage and risk factors. Ask your doctor what treatment schedule she or he recommends for you. Generally, follow-up after melanoma depends on your cancer stage and any symptoms that develop.2
- Stage 0 (melanoma in situ): Yearly examinations for life.
- Stage IA-IIA: Examination every 6 to 12 months for 5 years; followed by yearly examinations for life.
- Stage IIB-IV: Examination every 3 to 6 months for 2 years; every 3 to 12 months for 3 years; followed by yearly examinations for life.
Follow-up examinations may include imaging tests if:
- You have symptoms of possible cancer recurrence.
- You are at very high risk of recurrent or metastatic melanoma.
Lifetime follow-up is important. Melanoma may recur more than 10 years after the initial treatment.2
Risk factors for recurrence. The most important risk factor for recurrence is cancer stage the first time around.2 Early-stage melanoma recurs less frequently and later. Later-stage melanoma recurs more often and sooner.
Melanoma can recur at or near the original tumor. It can also recur in the lymph nodes or distant organs.
Treatment options for recurrent melanoma. Most treatment options are on the table for recurrent melanoma.2 Treatment will be chosen based on stage of the original tumor, previous treatment, and where the cancer recurs.
You may be treated with a primary treatment, followed by adjuvant treatment. Adjuvant treatment kills any cancer cells that remain. You will start with the treatments that are most likely to work (“first-line” therapy). If they are not working or they stop working, “second-line” therapies are offered. Second-line therapies may be in a different drug class than first-line therapy. They may be less effective or have more severe side effects.
Cancer confined to a skin tumor may be removed with surgery, injected with medication, or treated with radiation therapy or topical medication.2 Melanoma on the arm or leg may be treated with chemotherapy in that limb. If cancer recurs in the lymph nodes, they will be removed with surgery, if possible. Adjuvant treatment options include radiation, interferon-alfa, Yervoy® (ipilimumab), or biochemotherapy.
Metastatic disease may be treated with systemic (whole body) medications:
Your doctor may recommend participating in a clinical trial. If the cancer is very advanced, your doctor may recommend palliative therapy. The goal of palliative therapy is symptom relief, not cure.
- Miller SJ, Alam M, Andersen J, et al. Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw. 2010;8:836-864.
- NCCN Clinical Practice Guidelines in Oncology. Melanoma. Version 1.2017. Published November 10, 2016. https://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf
- NCCN Clinical Practice Guidelines in Oncology. Basal cell skin cancer. Version 1.2017. Published October 3, 2016. https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf
- NCCN Clinical Practice Guidelines in Oncology. Squamous cell skin cancer. Version 1.2017. Published October 3, 2016. https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf