Skin Checks After Melanoma: What Does Ongoing Surveillance Involve?

An evidence-based guide to skin checks, self-examination, lymph node checks and imaging after melanoma — updated August 2026

Finishing treatment for melanoma does not mean that skin checks stop.

People who have had a melanoma have two important reasons for ongoing follow-up:

1. A melanoma can sometimes come back.

2. A completely new melanoma can develop somewhere else on the skin.

These are different problems, and melanoma surveillance looks for both. Current European melanoma guidelines recommend ongoing whole-body examinations after melanoma to look for recurrence and new skin cancers.

The important point is that melanoma follow-up is not just a quick look at the old scar.

A good surveillance plan may include:

• a full skin examination;

• examination of the previous melanoma site;

• checking nearby skin;

• checking lymph nodes;

• regular self-checks between appointments;

• dermoscopy or photography for some people;

• and scans in selected people with a higher risk of recurrence.

Exactly what is needed depends on the stage of the original melanoma, how long ago it was treated, personal risk factors and any new symptoms. There is no single follow-up schedule that is right for every melanoma survivor.

Why are skin checks still important after melanoma?

A previous melanoma is itself an important risk factor for another melanoma.

A large Australian study published in 2025 followed 154,695 people in New South Wales who had previously been diagnosed with melanoma.

During follow-up, 12.7% developed another invasive or in-situ melanoma. The average risk of another melanoma within five years was about 7.6%. These figures describe that study population and should not be used to predict one person’s exact risk, but they show why long-term skin surveillance matters.

A 2024 systematic review involving more than 413,000 people with previous melanoma also confirmed that melanoma survivors have an increased risk of another primary melanoma. Risk was higher in some groups, including people with many moles, atypical moles, a family history of melanoma or certain inherited risk factors.

This means a person can have a very low risk of the original melanoma returning but still need ongoing skin checks because of the risk of developing a new melanoma.

A new melanoma is not the same as a recurrence

This distinction is important.

A recurrence means cells from the original melanoma have returned.

A second primary melanoma is a completely new melanoma that started independently in another group of skin cells.

Surveillance after melanoma therefore has more than one job.

Doctors are looking for:

• another melanoma on the skin;

• melanoma returning at or close to the original site;

• melanoma involving nearby lymph nodes;

• and, in people at higher risk, evidence that melanoma has returned elsewhere in the body.

Modern melanoma guidelines describe both recurrence detection and detection of new primary melanomas as major goals of follow-up.

What happens during a skin check after melanoma?

1. The whole skin should be examined

One of the most important parts of follow-up is a whole-body skin examination.

The clinician is not only looking at the place where the previous melanoma was removed.

They are looking for a new melanoma anywhere on the skin.

The 2025 European Society for Medical Oncology guideline recommends whole-body clinical examinations during melanoma follow-up, preferably by a dermatologist where appropriate, so that both recurrence and additional skin tumours can be found as early as possible.

This matters because another melanoma may appear nowhere near the first one.

2. The old melanoma site is checked

The area where the original melanoma was removed is also examined.

The clinician looks at the scar and surrounding skin for anything new or unusual.

Depending on the original melanoma, recurrence can sometimes develop in or around the previous treatment area or in the skin between the original melanoma and nearby lymph nodes.

This is one reason melanoma follow-up involves more than simply checking moles. Clinical examination is also aimed at detecting local and regional recurrence.

3. Lymph nodes may be checked

Melanoma can spread through the lymphatic system.

For this reason, follow-up examinations may include feeling the main groups of lymph nodes close to the area where the melanoma began.

For example, depending on the melanoma location, this may include the:

• neck;

• armpits;

• or groin.

European guidelines also recommend that melanoma survivors learn to check their own peripheral lymph nodes as part of lifelong self-surveillance.

Some people also have lymph node ultrasound surveillance, particularly when their stage or previous lymph-node treatment makes this useful.

A 2024 systematic review and meta-analysis involving more than 18,000 patients found that ultrasound can be effective at detecting melanoma involvement in regional lymph nodes. However, lymph-node ultrasound is not required for every melanoma survivor. Its use depends on stage and clinical circumstances.

How often should you have skin checks after melanoma?

There is no single answer.

This is an area where major international guidelines differ.

A review of 19 melanoma follow-up guidelines found considerable variation in how often patients were reviewed, how long specialist follow-up continued and when imaging was used. Just over half of the guidelines that addressed long-term skin surveillance recommended lifelong annual physician skin examinations.

The 2025 ESMO guideline therefore does not give one schedule for everyone. Instead, it recommends tailoring follow-up to:

• melanoma stage;

• individual risk;

• previous treatment;

• and the person’s needs.

There is a good reason for this.

The risk of the original melanoma returning is not the same throughout life. A 2026 review reports that recurrence risk is highest during the first couple of years after diagnosis and then generally falls with time.

The risk of developing a new melanoma, however, lasts much longer.

That is why appointments aimed at detecting recurrence may become less frequent with time, while ongoing skin surveillance remains important.

Does an early melanoma need the same follow-up as a higher-stage melanoma?

No.

Follow-up should reflect the original melanoma’s risk.

A thin, early melanoma that has been completely removed does not normally require the same surveillance as a melanoma that had a high risk of spreading or had already reached lymph nodes.

This difference is especially important when discussing scans.

Current European guidance, for example, does not recommend additional routine imaging for very thin melanomas up to 0.8 mm in the initial diagnostic setting. More intensive imaging is introduced at higher stages. Other countries use somewhat different schedules, which is why surveillance should follow the relevant local guideline and individual clinical circumstances.

The latest NCCN melanoma guideline, Version 2.2026, also uses melanoma stage and individual risk when planning management and follow-up.

What should you do between professional skin checks?

Professional appointments are only one part of surveillance.

Self-examination matters too.

The 2025 ESMO guideline recommends lifelong regular self-examination of both the skin and peripheral lymph nodes after melanoma.

A review of melanoma surveillance guidelines found that monthly self-examination had the strongest support in the available literature, although researchers have not established the perfect frequency in a randomised clinical trial.

The aim is not to diagnose melanoma yourself.

The aim is to become familiar with your skin so that you are more likely to notice a change.

Things worth showing your doctor include:

• a new spot;

• a mole or spot that is changing;

• a lesion that looks different from your other spots;

• a new lump under or near the skin;

• or a change around the previous melanoma scar.

If something concerns you, it is better to arrange a review rather than simply waiting for the next routine appointment.

Check the areas you cannot easily see

Melanoma can develop on parts of the body that are difficult to examine yourself.

These may include the:

• back;

• scalp;

• backs of the legs;

• soles of the feet;

• and areas behind the ears.

A partner or family member may be able to help with difficult-to-see areas.

The value of self-examination depends partly on actually being able to inspect the skin properly, which is why professional whole-body checks remain an important part of surveillance. Research into melanoma self-examination has also found that partner assistance and clinician support can improve self-checking behaviour.

What is dermoscopy?

During a skin check, the clinician may use a dermoscope.

A dermoscope is a small device that allows structures and colours beneath the skin surface to be seen more clearly.

It provides more information than looking at a mole with the naked eye alone.

Australian clinical practice recommendations state that clinicians examining people for melanoma should be trained in and use dermoscopy.

For someone who has already had melanoma, dermoscopy can be especially useful when there are many moles or lesions that are difficult to judge by eye.

What about total-body photography?

Some people are offered total-body photography.

This involves taking a set of photographs of the skin so that today’s appearance can be compared with future examinations.

This can be particularly useful for people who have:

• many moles;

• atypical moles;

• or other factors that place them at high risk of another melanoma.

Australian recommendations support considering total-body photography in people at increased melanoma risk, particularly those with high numbers of moles or dysplastic moles.

More recent research has looked at three-dimensional total-body photography combined with digital dermoscopy. These technologies can help clinicians track lesions over time, but they do not replace a full clinical skin examination, and research is still working out which patients benefit most and how these systems should best be used.

So more technology is not automatically better for every person.

It should be used when it answers a useful clinical question.

What is sequential digital dermoscopy?

Sometimes a lesion does not clearly look like melanoma, but the clinician does not want to ignore it.

Instead of removing it immediately, the lesion may be photographed through a dermoscope and compared with another image later.

This is called sequential digital dermoscopy.

The important question is:

Has the lesion changed?

Australian clinical practice recommendations support short-term digital monitoring of selected suspicious lesions and longer-term monitoring of selected lesions in people at high risk of melanoma.

This approach is not suitable for every suspicious lesion. A lesion that already has clear features suggesting melanoma may need biopsy rather than monitoring.

Do you need regular CT or PET scans after melanoma?

Not everyone does.

This is one of the biggest differences between follow-up after an early melanoma and surveillance after higher-risk melanoma.

For people with lower-risk melanoma and no symptoms, repeated body scans may offer little benefit.

For people with higher-risk melanoma, imaging may be used to look for recurrence before symptoms appear.

Depending on the situation, surveillance imaging can include:

• CT;

• PET/CT;

• and MRI of the brain.

A 2024 systematic review found that clinical follow-up alone may be appropriate for many people with stage IA–IIC melanoma, while imaging was more likely to find clinically important recurrence in selected higher-risk stage IIC–III patients. However, the authors rated much of the available evidence as low or very low certainty.

A 2024 review of high-risk melanoma surveillance reached a similar conclusion: imaging can be useful in high-risk disease, but the evidence does not support one perfect imaging schedule for every patient.

The American College of Radiology also published updated evidence-based melanoma imaging guidance in 2026, with imaging decisions based on factors such as local stage, lymph-node status, suspected recurrence and previous metastatic disease.

More scans are not always better

It is easy to assume that having frequent scans must be safer.

But surveillance imaging has disadvantages too.

Scans can find abnormalities that look suspicious but are not melanoma. These false-positive results can lead to more scans, biopsies, anxiety and sometimes unnecessary procedures.

CT and PET/CT also involve radiation exposure.

For this reason, modern surveillance strategies try to match the amount of imaging to the person’s actual risk rather than scanning everybody in the same way.

A 2026 review concluded that routine intensive imaging has not consistently shown a survival benefit across melanoma survivors and can increase false-positive findings and cost.

What about blood tests?

There is no blood test that replaces skin examination after melanoma.

Blood tests may be useful in particular clinical situations or as part of follow-up for certain higher-risk patients.

However, routine blood testing after completely treated melanoma is not agreed upon across international guidelines.

The 2025 ESMO guideline states that there is currently no consensus about the usefulness of routine blood tests or imaging for every patient with resected melanoma.

A review of international surveillance guidelines found that only 7 of 19 guidelines recommended routine laboratory investigations.

That is another reason surveillance should be based on stage and individual risk rather than a standard package of tests.

What if you develop symptoms between appointments?

Do not assume that surveillance only happens on the day of your skin check.

New symptoms can matter.

If a person who has previously had melanoma develops a persistent new lump or other unexplained symptoms, these should be discussed with the treating doctor rather than waiting months for the next scheduled visit.

A 2024 study examining symptoms associated with melanoma recurrence found that changes in appetite, unusual tiredness, enlarged lymph nodes, abdominal pain and shortness of breath were among symptoms associated with recurrence in its study population. However, this was a retrospective study and these symptoms are not specific to melanoma—many common conditions can cause them.

The practical message is simpler:

A new or persistent unexplained symptom deserves medical assessment, but it does not automatically mean melanoma has returned.

Sun protection remains part of follow-up

Surveillance is about finding melanoma early.

Prevention is also important.

The 2025 ESMO guideline advises people who have had melanoma to avoid sunburn, unprotected sun exposure and artificial ultraviolet exposure, such as tanning beds.

Sun protection cannot guarantee that another melanoma will not develop.

That is why protection and surveillance work together rather than replacing one another.

What does good melanoma surveillance look like?

A useful way to think about follow-up is in layers.

Layer 1: Your own skin checks

Become familiar with your skin and regularly look for something new or changing.

Layer 2: Professional whole-body skin examinations

These look for both a new melanoma and problems around the previous melanoma site.

Layer 3: Lymph node assessment

This may involve clinical examination and, for selected patients, ultrasound.

Layer 4: Dermoscopy and photography when useful

These tools can help doctors compare lesions and detect change, particularly in people with many moles or a high risk of another melanoma.

Layer 5: Imaging for selected higher-risk patients

CT, PET/CT, MRI or other imaging may be appropriate depending on melanoma stage, previous treatment and risk of recurrence.

Current guidelines support this risk-based approach rather than one identical surveillance plan for every melanoma survivor.

Skin surveillance and recurrence surveillance are not exactly the same

This is one of the most useful distinctions to understand.

The risk that the original melanoma will return generally falls as more time passes without recurrence.

But the risk of developing another melanoma does not disappear simply because many years have passed.

This means the need for repeated scans or intensive oncology appointments may decrease over time for some people.

The need to remain aware of the skin can continue much longer.

A review of melanoma guidelines found that many recommend lifelong annual professional skin surveillance, while ESMO recommends lifelong regular self-examination.

What can we say with confidence in 2026?

The bottom line

After melanoma, ongoing surveillance is about much more than checking one scar.

It has two major goals:

Finding recurrence of the previous melanoma.

and

Finding a new melanoma as early as possible.

The most important parts of follow-up are usually regular whole-body skin examinations, self-examination and appropriate checking of the previous melanoma site and lymph nodes.

Dermoscopy and photography can help some people.

Ultrasound, CT, PET/CT and MRI have important roles in selected patients, particularly those with higher-risk melanoma, but they are not required for every person who has had melanoma.

And there is no single follow-up timetable that fits everyone.

The best surveillance plan is based on the stage of the previous melanoma, personal risk of another melanoma, time since treatment, previous treatment and any new symptoms.

Perhaps the most important long-term message is simple:

Even when the risk of the original melanoma returning becomes low, the need to keep checking your skin does not disappear.

Key academic references

1. Swetter SM, et al. Melanoma: Cutaneous, Version 2.2026, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2026;24(6):272–277. doi:10.6004/jnccn.2026.0027.

2. Amaral T, et al. Cutaneous melanoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. 2025;36(1):10–30. doi:10.1016/j.annonc.2024.11.006.

3. Absolute risk of developing a second primary cancer after a first primary melanoma: an Australian population-based cohort study. American Journal of Epidemiology. 2025. Study of 154,695 people diagnosed with melanoma in New South Wales.

4. Smith J, Cust AE, Lo SN. Risk factors for subsequent primary melanoma in patients with previous melanoma: a systematic review and meta-analysis. British Journal of Dermatology. 2024;190(2):174–183.

5. Surveillance evaluations in patients with stage I, II, III, or resectable IV melanoma who were treated with curative intent: A systematic review. 2024.

6. Vetto JT. Clinical and Imaging Follow-Up for High-Risk Cutaneous Melanoma: Current Evidence and Guidelines. Cancers. 2024;16(14):2572.

7. Johnston L, et al. Surveillance After a Previous Cutaneous Melanoma Diagnosis: A Scoping Review of Melanoma Follow-Up Guidelines. 2023;27(5):516–525.

8. Liu ZF, et al. Ultrasound Surveillance in Melanoma Management: Bridging Diagnostic Promise with Real-World Adherence: A Systematic Review and Meta-Analysis. American Journal of Clinical Dermatology. 2024;25(4):513–525.

9. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics — Update 2024. Published 2024; guideline valid through the end of 2026.

10. Three-Dimensional Total Body Photography, Digital Dermoscopy, and in vivo Reflectance Confocal Microscopy for Follow-Up Assessments of High-Risk Patients for Melanoma: A Prospective, Controlled Study. Dermatology. 2024;240(5-6):803–813.

11. 3D Total-Body Photography in Patients at High Risk for Melanoma: A Randomized Clinical Trial. 2025.

12. ACR Appropriateness Criteria® Staging and Follow-Up of Melanoma. 2026.

13. Beyond Routine Surveillance Imaging for Melanoma: Emerging Technologies for Detecting Early Recurrence and Guiding Clinical Management. 2026.

This article is for general education and does not replace an individual melanoma surveillance plan. Follow-up should be based on the original melanoma stage, treatment history, individual risk factors and current national or specialist guidelines.