In primary care:

• Explain fully the clinical features of melanoma and how (or why) they develop.
• Advise patients that they will be referred to a specialist and how long they should expect to wait for an appointment.
• Advise patients that removal or biopsy of the tumour may occur at the initial visit.
• Explain how photo triage (if available) can be of benefit.

At the specialise clinic:

• Explain to patients how a diagnosis will be reached including:
  • clinical examination
  • types of biopsy and the need for local anaesthetic
  • how, when and by whom biopsy results will be given.
• With any surgical procedure, whether small biopsy or large excision, explain about surgical complications which include: pain, swelling, bleeding, bruising, loss of function and unpredictable scarring including keloid scarring.
• Advise patients about how long they should expect to spend at the hospital.
• Be clear about the time between biopsy results and treatment.
• Describe what treatments will be offered.
• Where possible, give patients written information about appointment waiting times and contact details.

• Discuss how well the treatment went and whether any further treatment is needed: surgery, radiotherapy or input from oncologists.
• Discuss the prognosis in light of the definitive treatment.
• Discuss the risk of recurrence and how the patient might detect this, and whether any tests are indicated to detect recurrence.
• Advise the patient about the likely length of follow up.
• Ensure patients are aware of the support available from a clinical nurse specialist and other health professionals eg Maggie’s centres, MacMillan Cancer Support or camouflage clinic and refer if appropriate.
• Allow sufficient time to discuss the following with patients:
  • psychological adjustment after a diagnosis and treatment for skin cancer
  • anxiety and low mood
  • coping strategies
  • being visibly different/stigma
  • use of camouflage and cosmetics
  • assessment and management of lymphoedema for those patients at risk.
• Advise patients to bring a written list of questions or concerns. A proforma that addresses these aspects can focus the discussion time.
• Offer patient education about self care for example:
  • self checking and getting to know their body, skin examination, checking lymph nodes
  • what to look for, eg features of abnormal skin lesions and what actions to take if they are concerned (it is also useful to detect any other health issues that require medical assessment).
  • discuss prevention including:
    • use of high-factor sunscreen and protective clothing
    • the damaging effects of sun beds
    • the need for precautions whilst working and taking holidays in the UK.
• Provide patients with written information leaflets and advise them how they can access self-help groups.

NHS inform – provides information and a directory of local support groups.

Cancer Support Scotland – provides emotional and practical support for anyone affected by cancer.

Cancer Research UK – provides patient information leaflets.

Changing Faces – charity that supports people living with conditions, marks and scars that affect their appearance.

Macmillan Cancer Support – provides information and care for people with cancer and their families.

Maggie’s Cancer Caring Centres – provides practical, eotinal and social support to people with cancer and their family and friends.

Marie Curie Cancer Care – provides care for people with cancer and supports research and education.

MASScot (Melanoma Action and Support Scotland) – Scottish charity for people who have experienced skin cancer.

Teenage Cancer Trust – offers care and support designed for and with young people.