About this ebook

This ebook is about a type of skin cancer called melanoma. It includes information about melanoma, how it is diagnosed and how it is treated with surgery.

Melanoma develops from cells in the skin called melanocytes (see The skin). These cells give our skin its colour. Not all skin cancers are melanomas. We have more information about non-melanoma skin cancer in Understanding skin cancer.

We hope this ebook answers your questions and helps you deal with some of your feelings. We can’t advise you about the best treatment for yourself. This information can only come from your doctor, who knows your full medical history.

We’ve included quotes from people affected by melanoma, including Ron, who is on the front cover of this ebook. To share your story, visit macmillan.org.uk/shareyourstory Other quotes are from healthtalk.org and some names have been changed.

At the end of this ebook are some useful addresses and websites (see Other useful organisations).

We have more information about melanoma, its treatment and coping after treatment that you may find useful. We’ve highlighted where this information is mentioned with this icon.

If you’d like to discuss this information, call the Macmillan Support Line free on 0808 808 00 00, Monday to Friday, 9am to 8pm. If you’re hard of hearing, you can use textphone 0808 808 0121, or Text Relay. For non-English speakers, interpreters are available. Alternatively, visit macmillan.org.uk

If you find this ebook helpful, you could pass it on to your family and friends. They may also want information to help them support you.

‘Being told was scary, but I had to get practical. I immediately thought of my son. I wanted to make sure I was well for him.’ Ron, diagnosed with melanoma in 2013

About melanoma

What is cancer?

Cancer starts in cells in our body. Cells are tiny building blocks that make up the organs and tissues of our bodies. They divide to make new cells in a controlled way. This is how our bodies grow, heal and repair. Cells receive signals from the body telling them when to divide and grow and when to stop growing. When a cell is no longer needed or can’t be repaired, it gets a signal to stop working and die.

Cancer develops when the normal workings of a cell go wrong and the cell becomes abnormal. The abnormal cell keeps dividing, making more and more abnormal cells. These eventually form a lump (tumour). Not all lumps are cancerous. Doctors can tell if a lump is cancerous by removing a small sample of tissue or cells from it. This is called a biopsy. The doctors examine the sample under a microscope to look for cancer cells.

A lump that is not cancerous (benign) may grow but cannot spread to anywhere else in the body. It usually only causes problems if it puts pressure on nearby organs.

A lump that is cancerous (malignant) can grow into nearby tissue. Sometimes, cancer cells spread from where the cancer first started (the primary site) to other parts of the body. They can travel through the blood or lymphatic system. When the cells reach another part of the body, they may begin to grow and form another tumour. This is called a secondary cancer or a metastasis.

The lymphatic system

The lymphatic system helps to protect us from infection and disease. It also drains lymph fluid from the tissues of the body before returning it to the blood. The lymphatic system is made up of fine tubes called lymphatic vessels that connect to groups of lymph nodes throughout the body.

Lymph nodes (sometimes called lymph glands) are small and bean-shaped. They filter bacteria (germs) and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.

The lymphatic system

The skin

The skin has many purposes, including:

- • acting as a barrier to protect the body from injury

- • keeping necessary fluids and proteins in the body

- • protecting the body from the harmful effects of ultraviolet (UV) light

- • helping control the body’s temperature.

The skin is divided into two main layers. The outer layer is known as the epidermis. The layer underneath is known as the dermis.

The epidermis contains three types of cell. On the surface are flat cells, known as squamous cells. Under these are rounder cells called basal cells. In between the basal cells are melanocytes.

The dermis contains nerve endings, blood vessels, and oil and sweat glands. It is held together by a protein called collagen.

Melanocytes

Melanocytes are cells that produce a pigment called melanin. Melanin is responsible for the natural colour of our skin. It also protects skin from the harmful effects of the sun.

When our skin is exposed to sunlight, our melanocytes increase the amount of melanin. This is to absorb more potentially harmful ultraviolet (UV) rays. This makes the skin darker and gives it a suntanned appearance. A suntan is a sign that the skin is trying to protect itself.

If you have naturally dark (brown or black) skin, you have the same number of melanocytes as people with white skin. But your melanocytes make more melanin. This means you have more natural protection from UV rays.

Moles are a group or cluster of melanocytes that are close together. They are sometimes called naevi. Most people with white skin have about 10 to 50 moles on their skin. Some people can have as many as 100.

The structure of the skin

About melanoma

Melanoma is a cancer that usually starts in the skin. It can start in a mole or in normal-looking skin. About half of all melanomas start in normal-looking skin.

The number of people developing melanoma is rising. Each year, about 14,500 people in the UK are diagnosed with melanoma. In the UK, melanoma is slightly more common in women than in men. It is one of the most common cancers in people aged 15 to 34. But, like most cancers, it is more common in older people.

People with dark skin are much less likely than people with fair skin to get melanoma. This is because their skin has more natural protection.

How melanoma develops

Melanoma develops from melanocytes (see The skin) that start to grow and divide more quickly than usual. In melanoma, the melanocytes also start to spread into the surrounding surface layers of skin. When they grow out of control, they usually look like a dark spot or an unusual-looking mole on your skin.

It is important to find and treat melanoma as early as possible. If a melanoma is not removed, the cells can grow down deeper into the layers of the skin. These layers contain tiny blood vessels and lymphatic vessels (see The skin). If the melanoma cells get into the blood or lymphatic vessels, they can travel to other parts of the body.

Early-stage or thin melanomas are unlikely to spread into the blood or lymphatic vessels. They are usually cured with surgery. There is more information about the different stages of melanoma in Staging melanoma.

Types of melanoma

There are four main types of skin melanoma:

- • Superficial spreading melanoma is the most common type. These types of melanoma are more commonly found on the arms, legs, chest and back. The melanoma cells usually grow slowly at first and spread out across the surface of the skin.

- • Nodular melanoma is the second most common type. It can grow more quickly than other melanomas. It is also more likely to lose its colour when growing, becoming red rather than black. It is more commonly found on the chest, back, head or neck.

- • Lentigo maligna melanoma is less common. It is usually found in older people, in areas of skin that have had a lot of sun exposure over many years. It is often found on the face and neck. It develops from a slow-growing precancerous condition called a lentigo maligna or Hutchinson’s freckle. This looks like a stain on the skin. They are usually slow-growing and less dangerous than the other types of melanoma.

- • Acral lentiginous melanoma is the rarest type. It is usually found on the palms of the hands, soles of the feet, or under fingernails or toenails. It is more common in people with black or brown skin. It isn’t thought to be related to sun exposure.

Another rare type of melanoma is desmoplastic melanoma.

Rarely, melanoma can start in parts of the body other than the skin. It can start in the eye (ocular melanoma). Or it can start in the tissues that line areas inside the body, such as the anus or rectum (anorectal melanoma), nose, mouth, lungs and other areas. For more information about these other types of melanoma, contact our cancer support specialists on 0808 808 00 00.

Causes and risk factors

Ultraviolet light exposure

The main risk factor for developing melanoma is exposure to UV radiation. This can be through natural sunlight or the artificial light used in sunbeds or sunlamps. UV radiation damages the DNA (genetic material) in our skin cells. This can cause skin cancers such as melanoma.

Sunlight

In the UK, the number of white people developing melanoma and other skin cancers is steadily rising. One of the reasons for this is increased sun exposure during sunny holidays. Increased public awareness has also led to a rise in the number of very early and thin melanomas being diagnosed.

It is important to be aware of the damage that too much sun exposure can cause. You should try to take steps to protect yourself. However, experts recommend regular exposure to a small amount of sunshine. This helps our bodies make vitamin D, which keeps our bones and teeth healthy. It also helps our immune system and has some anti-cancer effects.

The amount of exposure you need depends on your hair and skin type, the time of year and which part of the world you live in. It is important not to stay out in the sun for long enough to let your skin redden or burn. Severe sunburn that causes the skin to blister, especially during childhood, can increase the risk of melanoma in the future.

Sunbeds

Sunbeds use artificial UV rays that damage the DNA in your skin. They may increase the risk of melanoma. The more you use a sunbed or lamp, and the earlier in life you begin using them, the greater your risk.

It is important not to use sunbeds and to take precautions to protect yourself from too much sun exposure. This is especially important if you have had melanoma or any other type of skin cancer in the past. It is also important if you are at an increased risk of melanoma, which we talk about over the next .

Other factors

Although exposure to UV radiation from the sun or sunbeds is one of the main risk factors for developing melanoma, it is not the only one. Like other cancers, there are many things that may lead to melanoma developing.

Your skin type

People with fair skin, who have red or blond hair, green or blue eyes and freckles, are more sensitive to the sun. Because of their skin type, they burn more easily. This means they are more at risk of getting melanoma. Having naturally darker skin lowers your risk of getting melanoma. But it doesn’t mean that you will never get it. People from India, Asia and Africa have a lower risk of melanoma because their skin produces more melanin.

Having lots of moles and unusual moles

People who have a lot of moles, especially those with over 100 moles, have a higher risk of getting melanoma. So do people with moles that are bigger than average, or that have an irregular shape or colour. These moles are sometimes called atypical dysplastic naevi. They rarely change into melanoma, but it is important to check them regularly for changes. Having lots of moles and atypical moles can run in some families.

Your risk of melanoma is also increased if:

- • you were born with a dark, hairy mole

- • you were born with a large birth mark (over 20cm), known as a congenital naevi.

The risk from average size birth marks is very small.

If you have lots of moles or unusual moles, you can be referred to a skin specialist for advice and an assessment of your skin.

Family history of melanoma

Your risk of developing melanoma is increased if you have a close relative who has had melanoma. This may be because you have similar skin colour. But it could also be because a small number of melanomas (about 1 in 10, or 10%) are thought to be caused by genes that can run in families.

If you have a strong family history of melanoma, you may be referred to a genetic counsellor to discuss having a genetic test. The test will look for a gene called p16. This is a gene that can increase the risk of melanoma. The p16 gene may also be linked to an increased risk of pancreatic cancer. Your genetic counsellor will also discuss this with you. However, like all cancers, melanoma may be caused by a large number of genes that we can’t test for yet.

People with a very strong family history of melanoma and other types of cancer should be referred by their GP to a dermatologist and the family cancer clinic.

Our booklet Cancer genetics – how cancer sometimes runs in families has more information that you may find useful.

Reduced immunity

People with a weakened immune system have an increased risk of melanoma. This could be due to HIV or taking drugs that suppress the immune system, for example after an organ transplant.

Symptoms

About half of all melanomas start with a change in previously normal-looking skin. This usually looks like a dark area or an abnormal new mole that changes over weeks or months. Other melanomas develop from a mole that you already have.

It can be difficult to tell the difference between a melanoma and a normal mole. The following checklist is known as the ABCDE list. It helps explain what to look for.

Photographs are from the website of the National Cancer Institute (cancer.gov).

Asymmetry

Most melanomas are likely to be an irregular shape and not symmetrical (asymmetrical). Ordinary moles are usually symmetrical, which means that both halves look the same.

Melanoma with asymmetrical shape

Normal mole with symmetrical shape

Border

Melanomas are more likely to have a blurred or irregular border with jagged edges. Ordinary moles usually have a well-defined, smooth-edged border.

Melanoma with irregular border

Normal mole with clear border

Colour

Melanomas tend to be more than one colour. They may have different shades, such as brown mixed with a black, red, pink, white or blue tint. Normal moles tend to only have shades of brown.

Melanoma with colour difference

Normal mole with no colour difference

Diameter (width)

Melanomas are usually more than 6mm wide. Normal moles are not usually bigger than the blunt end of a pencil.

If you have lots of large moles, some of them may be larger than 5mm in diameter. These are likely to have been there for years without change. But it is recommended that people with large moles get them checked by a dermatologist.

Melanoma with a diameter change

Normal mole with no diameter change

Evolving (changing)

If you notice any changes to a mole, you should visit your GP. The changes may be in the size, shape or colour of the mole, or if the area becomes raised or dome-shaped.

When to see a doctor

Visit your doctor straight away if you have:

- • any of the ABCDE signs

- • any unusual marks on the skin that last for more than a few weeks

- • a mole that tingles or itches

- • a mole that develops a crust or bleeds

- • something growing under a nail or a new dark-coloured stripe along part of the nail.

A good time to check your skin is after a bath or shower. Make sure you have plenty of light. Use a full-length mirror and a small hand held mirror for areas that are hard to see. This will get easier with time as you become more familiar with your skin and what your moles normally look like.

You can ask your partner, a relative or friend to look at your back, neck and parts of your skin that are hard to see. You could also take pictures of your moles so you can see if there are any changes over time. Checking for these signs is very important, as melanoma can usually be cured if it is found at an early stage.

‘I noticed a slight change in the mole. The results showed it was a melanoma. They congratulated me on spotting it and I think myself very lucky. I think only by reading about the signs of cancer on websites like Macmillan’s, I was able to spot it very early.’ Jessica

Diagnosing melanoma

How melanoma is diagnosed

Your GP will usually examine you first. If they think you may have a melanoma, they should refer you to a doctor with specialist training in diagnosing skin conditions. This could be a dermatologist or a plastic surgeon. If they think it may be cancer, you should be seen at the hospital within two weeks.

Seeing a specialist

Your appointment will probably be at a skin clinic or a pigmented lesion clinic. This is a special clinic for diagnosing melanomas early.

The specialist will examine your mole. They will ask you questions about how long you have had it and any changes you have noticed. They will usually take a photograph of the mole. They will often examine the rest of your skin to see if you have any other unusual moles and may take photographs of them. This is so they can check whether the moles change over time.

Some specialists may look at your moles with a small, hand held instrument called a dermatoscope. This gives a bigger and clearer picture of the mole. Your specialist will know a lot from looking at your mole. It is also important that they know whether the mole has changed over time and how it has changed.

If the specialist thinks you may have a melanoma, they will advise you to have the whole mole removed. You will normally have to come back for a second appointment for this to be done. You may see a specialist skin cancer nurse, who will give you information and support.

If it isn’t clear that your mole is a melanoma, your specialist will ask you to come back in a few months. At the second appointment, they can check if the mole has changed since it was photographed.

Having your mole removed

Your mole needs to be removed so that the doctor can find out what it is. This is known as an excision biopsy. You will have a small scar afterwards.

Before the mole is removed, your doctor will explain the procedure to you. You will be asked to sign a form saying that you give your permission (consent) for the mole to be removed.

Once you are lying down comfortably, the doctor or a specialist nurse will inject a local anaesthetic into the area around the mole. This will numb the area so you don’t feel any pain. They will cut out the whole mole and 2mm of normal skin around it. The wound will be closed using stitches, which will be removed after 5 to 14 days, depending on where the mole was. Some people may have stitches that dissolve, which means they don’t need to be removed.

The mole is then examined under a microscope to see if any melanoma cells are present.

Waiting for test results

Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse or one of the organisations listed in Other useful organisations can also provide support. You can also talk to one of our cancer support specialists on 0808 808 00 00.

Your data and the cancer registry

When you are diagnosed with cancer in the UK, some information about you is collected in a national database. This is called the cancer registry. It helps the NHS and other organisations plan and improve health and care services. Your hospital will give information about you, your cancer diagnosis and treatment to the registry automatically, unless you ask them not to. As with all medical records, there are strict rules to make sure the information is kept safely and securely. It will only be used for your direct care or for health and social care planning and research. You can find more information at macmillan.org.uk/cancerregistry

Talk to your doctor or nurse if you have any questions about the registry. If you do not want your information included in the registry, you can contact the cancer registry in your country.

‘I had a mole on my lower left jaw. My friend told me that a black patch had appeared on it and I should get it checked.’ Ron

Staging melanoma

This section gives a simple summary of the stages of melanoma. We have more detailed information about staging in Detailed staging of melanoma

The stage of a cancer is a term used to describe its size and whether it has spread. Knowing the stage of your cancer helps doctors decide on the best treatment for you.

Your specialists can give you more information about the stage of your melanoma.

Melanoma in situ (stage 0)

Melanoma in situ is a term used to describe the earliest stage of melanoma. It is also called melanocytic intraepithelial neoplasia. This means the melanoma cells are only in the top layer of skin (epidermis) and haven’t started to spread down into the dermis (see The skin). Because of this, people with melanoma in situ do not usually have any risk of the melanoma spreading to other parts of the body.

Stages 1 and 2

The melanoma is only in the skin and has not spread anywhere else in the body.

Stage 3

The melanoma has spread to the nearest lymph vessels or nodes (see The lymphatic system), but not to anywhere else in the body.

Stage 4

The melanoma has spread to distant areas of skin, or to other organs such as the lung, liver or brain. This is called advanced or metastatic melanoma.

Breslow thickness

When melanomas are staged, doctors also use a measurement to describe how thick (deep) the melanoma is. This is called the Breslow thickness. It measures in millimetres (mm) how far the melanoma cells have grown down into the layers of skin.

Most people have melanomas that are 1mm thick or less. These are stage 1 melanomas. They are often known as thin melanomas and they are very unlikely to spread. Most can be cured by a simple operation called a wide local excision (see Surgery).

If a melanoma is thick, it is more likely to spread into the lymph vessels or nodes closest to the melanoma. If this happens, additional surgery will be needed to remove the lymph nodes as well as the melanoma.

Our booklet Understanding melanoma – lymph node assessment and treatment has more information.

Detailed staging of melanoma

In the previous section, we explained the stages of melanoma (see Staging melanoma). Here we give some more detailed information about staging.

The staging system used for melanoma is the American Joint Committee on Cancer (AJCC) system. It uses the TNM system:

T stands for tumour. It describes the thickness (depth) of the melanoma and uses the Breslow thickness (see Breslow thickness). It also describes whether the melanoma is ulcerated and what its mitotic rate is. A melanoma is ulcerated if the layer of skin covering the melanoma is broken. Mitotic rate describes the number of cells that are in the process of dividing in a certain amount of melanoma tissue. A higher mitotic rate means that the cancer has a greater risk of spreading.

N stands for lymph nodes. It describes whether the melanoma has spread to the lymph nodes and, if so, to how many.

M stands for metastases. It describes whether the melanoma has spread to other parts of the body (secondary or metastatic cancer).

The AJCC system groups melanomas into an overall number stage between 0 and 4.

The different levels of tumour thickness

There are five levels of tumour thickness:

- • Tis – the melanoma cells are only in the very top layer of the skin (epidermis).

- • T1 – the melanoma is 1mm thick or less.

- • T2 – the melanoma is between 1mm and 2mm thick.

- • T3 – the melanoma is between 2mm and 4mm thick.

- • T4 – the melanoma is more than 4mm thick.

Overview of staging

Stage 0 – the melanoma is only in the top layer of the skin (epidermis). It has not begun to spread into deeper layers.

Stage 1 melanoma is no more than 2mm thick and has not spread beyond the skin. Stage 1 is divided into two sub-stages.

- • Stage 1A The melanoma is 1mm thick or less, without ulceration. It has a mitotic rate of less than 1/mm2.

- • Stage 1B The melanoma is 1mm thick or less. It also has either ulceration or a mitotic rate of at least 1/mm2 or The melanoma is between 1.01mm and 2mm thick, but doesn’t have ulceration.

Stage 2 – the melanoma has not spread to the lymph nodes or anywhere else in the body. Stage 2 is divided into three sub-stages.

- • Stage 2A The melanoma is between 1.01mm and 2mm thick, with ulceration or The melanoma is between 2.01mm and 4mm thick, without ulceration.

- • Stage 2B The melanoma is between 2.01mm and 4mm thick, with ulceration or The melanoma is thicker than 4mm, without ulceration.

- • Stage 2C The melanoma is thicker than 4mm with ulceration.

Stage 3 – the melanoma has spread to the lymphatic vessels or lymph nodes closest to the melanoma. It has not spread to anywhere else in the body. It can be of any thickness. Stage 3 is divided into three sub-stages.

- • Stage 3A The melanoma has spread into up to three lymph nodes. The melanoma cells in the nodes can only be seen under a microscope (micrometastasis). There is no ulceration.

- • Stage 3B The melanoma is ulcerated and has spread into up to three lymph nodes. The melanoma cells in the nodes can only be seen under a microscope or The melanoma has spread into up to three lymph nodes. The nodes are enlarged (macrometastasis). There is no ulceration or The melanoma has spread into two or three lymph nodes. It has also spread to the skin or lymphatic vessels near the melanoma. There is no ulceration.

- • Stage 3C The melanoma is ulcerated and has spread into up to three lymph nodes. The nodes are enlarged or The melanoma is ulcerated. It has spread into two or three lymph nodes. It has also spread to the skin or lymphatic vessels near the melanoma or The melanoma may or may not be ulcerated. It has spread into four or more lymph nodes or The melanoma may or may not be ulcerated. It has spread into lymph nodes that have joined together.

Stage 4 – the melanoma has spread to distant areas of skin or distant lymph nodes. Or it has spread to other organs such as the lungs, liver or brain.

The way cancers are staged is complicated. If you have any questions about the stage of the melanoma, ask your doctor.

‘They found a malignant melanoma that I needed to have cut out. It was 2mm and they needed to cut out an inch around it.’ Ron

Treating melanoma

Treatment overview

If the results of your excision biopsy (see How melanoma is diagnosed) confirm that you have a melanoma, you may be seen by two or more specialists. They will work as part of a multidisciplinary team (MDT). The team may include:

- • dermatologists – doctors who specialise in skin conditions

- • skin cancer nurse specialists

- • plastic surgeons

- • oncologists – doctors who specialise in treating cancer.

The MDT will meet to discuss which treatment plan they feel is best for you. They will consider a number of things, such as your general health, the stage of the melanoma and where it is on your body.

Most people diagnosed with melanoma will have surgery after their mole has been removed. This surgery is known as a wide local excision (see Surgery). It is done to make sure that all the melanoma cells in the area where the mole was have been removed. This reduces the chance of the melanoma coming back.

We have a video about treatment for melanoma at macmillan.org.uk/melanomatreatment In this video, a skin cancer nurse explains the surgery and a woman who had melanoma shares her story.

Giving your consent

Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent. Before you are asked to sign the form you should be given full information about:

- • the type and extent of the treatment

- • its advantages and disadvantages

- • any significant risks or side effects

- • any other treatments that may be available.

If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again.

It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.

People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.

You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.

Second opinion

Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion.

Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you. Have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Surgery

Most people will have surgery after their biopsy. This is to remove more skin tissue from the area. It is known as a wide local excision. It makes sure that there are no melanoma cells left behind.

Very occasionally, you may not need to have a wide local excision. This happens if enough non-cancerous tissue was taken away when your melanoma was removed.

Before your surgery

Before you have surgery, the specialist will examine your lymph nodes (see The lymphatic system). This is because the most common place for melanoma cells to spread to are the lymph nodes closest to the melanoma.

Your specialist will check whether they look or feel swollen. If the melanoma is on your leg, they will examine the lymph nodes behind your knee and in your groin. If it is on your chest, back or abdomen, they will check the lymph nodes in your groin, armpits, above the collarbones and in the neck.

Your specialist will suggest you have tests to check your lymph nodes if:

- • any of them are swollen

- • there is a possibility they may contain cancer cells.

Some people may be offered a test to check their lymph nodes even if they aren’t swollen. This test is done at the same time as the surgery. It is known as a sentinel lymph node biopsy.

Stage 1 melanomas rarely spread to the lymph nodes. This means you won’t usually need tests to check them.

We have more information about these tests in our booklet Understanding melanoma – lymph node assessment and treatment.

Wide local excision

During a wide local excision, the surgeon removes an amount of normal-looking tissue from around the area where the melanoma was, including underneath it. This is known as a margin. It is done to make sure that no melanoma cells have been left behind.

The amount of skin that is removed will depend on how far the melanoma has grown into the deeper layers of the skin. Your specialist will let you know how much skin will be removed. You will usually have the wide local excision under a local anaesthetic, in the day surgery unit. It may sometimes be done under a general anaesthetic.

The wound can usually be stitched together. Your specialist nurse will talk to you about how to look after the wound area. It will look red and sore at first, but this will gradually get better. Your stitches will be removed 5 to 14 days later, depending on where the melanoma was. You will be left with a scar, which is usually small and becomes less noticeable with time.

Sometimes, the wound may be too big to stitch together. In this case, you may need to have a skin graft or a skin flap to mend the wound.

Skin grafts

A skin graft is a layer of skin taken from another part of the body and placed over the area where the melanoma was removed. The place where the skin is taken from is known as the donor site. The place where it is moved to is called the grafted area. The amount of skin that is taken depends on the size of the area to be covered. Your doctor or specialist nurse will tell you more about this.

The donor site

You will have a dressing on the donor site to protect it from infection. How long the site takes to heal will depend on how much skin was removed. If skin was taken from the thigh, buttock or upper arm, it may take up to two weeks to heal. If it was taken from the neck, behind the ears or the inner side of the upper arm, it may only take about five days to heal. The donor site can often feel more uncomfortable than the grafted area. You may need to take regular painkillers for a while.

The grafted area

The grafted area may be secured with stitches. You will have a dressing over it, which will be left in place while the graft heals. The skin graft will connect with the blood supply in the area. This usually takes five to seven days. The areas will look red and swollen to begin with, but eventually it will heal and the redness will fade.

After skin graft surgery

After a skin graft, you can usually go home on the same day. Some people need a short stay in hospital depending on where the graft is and how big it is.

Try not to do too much during the first couple of weeks after surgery. You will need to allow the graft to heal properly. The grafted area will be quite fragile. It is important not to put pressure on it, or rub or brush against it.

Some people may need to take some time off work until it has healed. If you have young children, you may need some extra help at home until you feel able to do the things you normally do.

Your stitches will be removed 5 to 14 days after your operation. Some people may have stitches that dissolve and don’t need to be removed.

Both the grafted and donor areas will develop scars. These should gradually become less noticeable. There will also be some difference between the grafted skin and the skin surrounding it. This will lessen over time. Your hospital team can tell you more about what to expect.

Skin flaps

A skin flap is a slightly thicker layer of skin than a graft. It is taken from an area very close to where the melanoma was. The flap is cut away but left partially connected, so it still has a blood supply. It is moved over the wound and stitched in place. If you have a skin flap, you may need to stay in hospital for a few days.

Skin flap surgery is very specialised. It is usually done by a plastic surgeon. You may have to travel to a different hospital to have it. If you need a skin flap, your doctor will be able to tell you more about it.

Coping with a change in appearance

Depending on your surgery, you may have some small scars. Or you may have larger areas of skin that look different. Some scars may be more visible, for example if they are on your face.

People cope with changes in appearance differently. Some people may not be upset by them. Others find these changes harder to cope with or feel self-conscious. It isn’t always related to the size or visibility of the change. A small, hidden scar can still affect a person’s confidence. Everyone is different.

Give yourself time to get used to the changes. You may find you feel better about them after a while. Scars will also become less noticeable as time goes on.

‘I wasn’t too worried about the scar. It was something that I knew had to be done, so I was happy to do it. If this is all I have to live with following my diagnosis, I am happy with that.’ Ron

Some skin clinics have a make-up specialist who can advise you on the best way to cover up scars. There are also organisations that provide camouflage make-up to cover up scars (see Other useful organisations).

If you are finding things difficult, it is important to get support. You may find it helps to talk to your hospital team, someone close to you or a trained counsellor. The organisations listed at the end of this ebook can also help (see Other useful organisations).

You may find it helpful to read Body image and cancer.

Further tests and treatment

If all the melanoma cells are removed during your wide local excision, you won’t need any further treatment.

Tests to check the nearby lymph nodes sometimes show that the melanoma has spread to them. If this happens, you will be offered further surgery to remove all the nearby lymph nodes.

Sometimes, other drug treatments are given after surgery if there is a risk the melanoma could come back. These are called adjuvant treatments. They are usually given as part of a clinical trial. Your hospital team will let you know if adjuvant treatments are suitable for you.

Understanding melanoma – lymph node assessment and treatment describes some of these tests and treatments in more detail. We also have information about clinical trials. You can order copies from be.macmillan.org.uk or by calling 0808 808 00 00.

After treatment

Follow-up

After the melanoma has been removed, you will see your skin cancer specialist again for a follow-up appointment.

During this appointment, your doctor or specialist nurse will examine your scar and the surrounding area. They will also check your lymph nodes (see The lymphatic system). Which lymph nodes they check will depend on where the melanoma was:

- • Leg – the lymph nodes behind your knees and in your groin will be checked.

- • Chest, back or abdomen – the lymph nodes in your groin, armpits, above the collarbones and in the neck will be checked.

- • Arm – the lymph nodes around the elbow, above your collarbones and in the lower neck will be checked.

- • Head or neck area – the lymph nodes in the side of your neck, under the chin, above the collarbones, behind your ears and at the back of your neck will be checked.

Your specialist will also check the rest of your skin for any signs of new melanomas. Some people may have photographs taken of their skin and some of their moles measured. This is just a way of checking for any changes that may develop.

How often you have follow-up appointments and how many you need will depend on the stage of your melanoma. Your specialist will discuss this with you.

You will be shown how to examine your skin and what to look out for. This will help you spot any signs of the original melanoma coming back, or another melanoma developing, as early as possible.

After you have had a melanoma, you are more at risk of developing another primary melanoma. So you will also be given advice on protecting your skin from the sun (see Skin care in the sun).

‘Surviving cancer makes you evaluate what’s important in life. If you notice a freckle or mole, or if a new one suddenly appears, get it checked out straight away. And stay safe in the sun – a tan really isn’t worth it.’ Courtney

After melanoma

What to look out for

It is important to check yourself for any signs of melanoma at least once a month. If another melanoma develops, there is more chance of curing it the earlier it is found. If you have any symptoms that you are worried about, you can contact your hospital doctor or specialist nurse between your follow-up appointments.

You will be asked to check:

- • your scar and the surrounding area

- • the lymph nodes nearby

- • your skin, from head to toe, for any new or changing moles – use the ABCDE list in Symptoms.

The British Association of Dermatologists (see Other useful organisations) produce a leaflet with advice about how to check your lymph nodes. You can download a copy from their website – visit bad.org.uk

Skin care in the sun

After treatment for melanoma, it is important to protect your skin from the sun. This doesn’t mean that you can no longer enjoy sunshine or have holidays in sunny countries. But you will need to be careful. You must make sure your skin does not burn. Over time, this will become part of your normal routine.

There are a number of things you can do to protect your skin:

- • Stay out of the sun or strong sunlight during the hottest part of the day. This is usually between 11am and 3pm.

- • Wear clothing made of cotton or natural fibres, which have a close weave. These will give you more protection against the sun.

- • Keep your arms and legs covered by wearing long-sleeved tops and trousers. Wear a wide-brimmed hat to protect your face, neck and ears.

- • Always wear sunglasses in strong sunlight.

- • Use a high-factor suncream (SPF 30 or above) whenever you are exposed to the sun for a period of time. Follow the instructions on the bottle and re-apply it as recommended. In the autumn, winter and early spring in the UK, there is no need to use above SPF 20 if you only have limited exposure to the sun.

- • Choose a suncream that protects against UVA and UVB radiation. This is known as broad spectrum suncream.

- • Don’t use suncream instead of other methods of protecting your skin. Some people think that if they use suncream, they can stay out in the sun for longer. But the best protection is to cover up and to stay out of strong sunlight.

- • Never use a sunbed or sunlamp. If it is important for you to look tanned, use fake tan lotions or sprays.

- • If you have a skin condition and use a sunbed as part of your treatment, your dermatologist may advise you to stop using the sunbed.

- • If you aren’t often exposed to the sun, you may want to ask your specialist or GP to check your vitamin D levels. This vitamin is important for general health and can get very low in people who avoid the sun. You may need to take vitamin D supplements.

‘I use hats and long-sleeved tops, and I cover myself with suncream now. I don’t take any chances, because I don’t want to repeat my mistakes.’ Ron

Pregnancy

Having a family can be an important part of moving on with life after cancer. If you are thinking of becoming pregnant or fathering a child after having melanoma, talk to your specialist first. In some situations, they may advise you to avoid having children for a couple of years after your diagnosis. This is because this is the most likely time for melanoma to come back.

For women who do become pregnant, there is no evidence that this will make a melanoma more likely to come back.

Well-being and recovery

After your treatment, you may want to think about making changes to your lifestyle and finding out more about healthy living. There are things you can do to help your body recover. These can also help improve your sense of well-being and lower your risk of getting other illnesses and some cancers.

Eat well and keep to a healthy weight

Eat at least five portions of fresh fruit and vegetables a day. Try to eat more foods that are high in fibre, such as wholemeal, cereal, beans and grains. Eat less red meat, animal fats and salted, pickled and smoked foods. Follow sensible drinking guidelines.

Exercise regularly

Exercise can be an important part of your recovery after treatment. It can improve your well-being and energy levels. It reduces the risk of heart disease, stroke, diabetes and bone thinning (osteoporosis). Talk to your cancer specialist or GP before you start. Start slowly and increase your activity over time.

Stop smoking

If you are a smoker, speak to your doctor or call a stop smoking helpline. They can give you advice and tell you where to find your local stop smoking service.

We can send you information about eating well, exercise and stopping smoking. We also have a booklet called Life after cancer treatment that may be helpful.

Your feelings and relationships

Your feelings

It is common to feel overwhelmed by different feelings when you are told that you have melanoma. We talk about some of these here. Partners, family and friends may also have some of the same feelings. You might have different reactions to the ones we describe here. There is no right or wrong way to feel. You will cope with things in your own way. Talking to people close to you or other people affected by cancer can often help.

You may find it hard to believe it when your doctor tells you that you have melanoma. It is common to feel shocked and numb. You may not be able to take in much information and find that you keep asking the same questions again and again. At first, you might find it hard to talk to family and friends about the cancer. This usually gets easier as the shock wears off. Or you may find you can’t think or talk about anything but the melanoma. This is because your mind is trying to process what you’re going through.

People can be very anxious about whether treatment will work and what will happen in the future. This uncertainty can be one of the hardest things to cope with. It is best to talk to your doctor about your individual treatment and what is likely to happen. They may not be able to answer your questions fully, but they can usually talk through any problems with you and give you some guidance.

You may feel angry about your illness. This is a normal reaction. You may get angry with the people close to you. Let them know that you are angry at your illness and not at them. Finding ways to help you relax and reduce stress can help with anger. This can include talking about or writing down how you feel, gentle exercise, breathing or relaxation therapy, and yoga or meditation.

Some people feel guilty or blame themselves or others for the melanoma. You may try to find reasons for why it has happened to you. Most of the time, it’s impossible to know exactly what has caused the cancer.

‘I think the most important thing is to be open. I think you’ve got to be very honest with yourself about how you’re feeling.’ Ellie

If you need more support, you can call the Macmillan Support Line free on 0808 808 00 00 and talk to one of our cancer support specialists. Our website can help you find out about local support groups – visit macmillan.org.uk/supportgroups

You can also talk to other people going through the same thing on our online community at macmillan.org.uk/community

Worrying about the cancer coming back

One of the biggest and most common worries people have after treatment is that their cancer may come back. Even if your melanoma has been cured, you may still worry.

Our booklet How are you feeling? The emotional effects of cancer discusses the feelings you may have in more detail, and has suggestions for coping with them. You may also find our booklet Worrying about cancer coming back helpful. It includes suggestions about how to cope and tells you where to get further support.

If you are a relative or friend

Some people find it hard to talk about cancer or share their feelings. You might think it’s best to pretend everything is fine, and carry on as normal. You might not want to worry the person with cancer, or you might feel you’re letting them down if you admit to being afraid. Unfortunately, denying strong emotions can make it even harder to talk, and may lead to the person with cancer feeling very isolated.

Partners, relatives and friends can help by listening carefully to what the person with cancer wants to say. It may be best not to rush into talking about the illness. Often it’s enough just to listen and let the person with cancer talk when they are ready.

You may find some of the courses on our Learn Zone website helpful. There are courses to help with listening and talking, to help friends and family support their loved ones affected by cancer. Visit macmillan.org.uk/learnzone to find out more.

Our booklet Talking with someone who has cancer has more suggestions if you have a friend or relative with cancer. If you’re looking after a family member or friend with cancer, you may find our booklet Looking after someone with cancer helpful. It’s based on carers’ experiences and has lots of practical tips and information.

We have more information about supporting someone with cancer at macmillan.org.uk/carers

Talking to children

Deciding what to tell your children or grandchildren about your cancer is difficult. An open, honest approach is usually best. Even very young children can sense when something is wrong, and their fears can sometimes be worse than the reality.

How much you tell your children will depend on their age and how mature they are. It may be best to start by giving only small amounts of information, and gradually tell them more to build up a picture of your illness.

Teenagers

Teenagers can have an especially hard time. At a stage when they want more freedom, they may be asked to take on new responsibilities and they may feel over-burdened. It’s important that they can go on with their normal lives as much as possible and still get the support they need.

If they find it hard to talk to you, you could encourage them to talk to someone close who can support and listen to them, such as a grandparent, family friend, teacher or counsellor. They may also find it useful to look at the website riprap.org.uk

which has been developed especially for teenagers who have a parent with cancer.

Our booklet Talking to children when an adult has cancer includes discussion about sensitive topics. There’s also a video on our website that may help, at macmillan.org.uk/talkingtochildren

Further information

About our information

We provide expert, up-to-date information about cancer. And all our information is free for everyone.

Order what you need

You may want to order some leaflets or booklets, or download more ebooks like this one. Visit be.macmillan.org.uk or call us on 0808 808 00 00.

We have booklets on different cancer types, treatments and side effects. We also have information about work, financial issues, diet, life after cancer and information for carers, family and friends.

All of our information is also available online at macmillan.org.uk/cancerinformation There you’ll also find videos featuring real-life stories from people affected by cancer, and information from health and social care professionals.

Other formats

We also provide information in different languages and formats, including:

- • audiobooks

- • Braille

- • British Sign Language

- • Easy Read booklets

- • large print

- • translations.

Find out more at macmillan.org.uk/otherformats If you’d like us to produce information in a different format for you, email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

Help us improve our information

We know that the people who use our information are the real experts. That’s why we always involve them in our work. If you’ve been affected by cancer, you can help us improve our information.

We give you the chance to comment on a variety of information including booklets, leaflets and fact sheets.

If you’d like to hear more about becoming a reviewer, email reviewing@macmillan.org.uk You can get involved from home whenever you like, and we don’t ask for any special skills – just an interest in our cancer information.

Other ways we can help you

At Macmillan, we know how a cancer diagnosis can affect everything, and we’re here to support you. No one should face cancer alone.

Talk to us

If you or someone you know is affected by cancer, talking about how you feel and sharing your concerns can really help.

Macmillan Support Line

Our free, confidential phone line is open Monday–Friday, 9am–8pm. Our cancer support specialists can:

- • help with any medical questions you have about your cancer or treatment

- • help you access benefits and give you financial advice

- • be there to listen if you need someone to talk to

- • tell you about services that can help you in your area.

Call us on 0808 808 00 00 or email us via our website, macmillan.org.uk/talktous

Information centres

Our information and support centres are based in hospitals, libraries and mobile centres. There, you can speak with someone face to face.

Visit one to get the information you need, or if you’d like a private chat, most centres have a room where you can speak with someone alone and in confidence.

Find your nearest centre at macmillan.org.uk/informationcentres or call us on 0808 808 00 00.

Talk to others

No one knows more about the impact cancer can have on your life than those who have been through it themselves. That’s why we help to bring people together in their communities and online.

Support groups

Whether you are someone living with cancer or a carer, we can help you find support in your local area, so you can speak face to face with people who understand. Find out about support groups in your area by calling us or by visiting macmillan.org.uk/selfhelpandsupport

Online community

Thousands of people use our online community to make friends, blog about their experiences and join groups to meet other people going through the same things. You can access it any time of day or night. Share your experiences, ask questions, or just read through people’s posts at macmillan.org.uk/community

The Macmillan healthcare team

Our nurses, doctors and other health and social care professionals give expert care and support to individuals and their families. Call us or ask your GP, consultant, district nurse or hospital ward sister if there are any Macmillan professionals near you.

Help with money worries

Having cancer can bring extra costs such as hospital parking, travel fares and higher heating bills. If you’ve been affected in this way, we can help.

Financial guidance

Our financial guidance team can give you advice on mortgages, pensions, insurance, borrowing and savings.

Help accessing benefits

Our benefits advisers can offer advice and information on benefits, tax credits, grants and loans. They can help you work out what financial help you could be entitled to. They can also help you complete your forms and apply for benefits.

Macmillan Grants

Macmillan offers one-off payments to people with cancer. A grant can be for anything from heating bills or extra clothing to a much-needed break.

Call us on 0808 808 00 00 to speak to a financial guide or benefits adviser, or to find out more about Macmillan Grants. We can also tell you about benefits advisers in your area.

Visit macmillan.org.uk/financialsupport to find out more about how we can help you with your finances.

Help with work and cancer

Whether you’re an employee, a carer, an employer or are self-employed, we can provide support and information to help you manage cancer at work. Visit macmillan.org.uk/work

Macmillan’s My Organiser app

This free mobile app can help you manage your treatment, from appointment times and contact details, to reminders for when to take your medication. Search ‘My Organiser’ on the Apple App Store or Google Play on your phone.

Other useful organisations

There are lots of other organisations that can give you information or support.

The British Association of Dermatologists (BAD)

Willan House, 4 Fitzroy Square, London W1T 5HQ

Tel 020 7383 0266

Email info@bad.org.uk

www.bad.org.uk

Offers information leaflets that can be downloaded from the website. Has another website offering emotional support for people with different skin conditions – visit skinsupport.org.uk

The British Association of Skin Camouflage

PO Box 3671, Chester,Cheshire CH1 9QH

Tel 0125 470 3107

www.skin-camouflage.net

Shows people how to use make-up as skin camouflage.

Changing Faces

The Squire Centre, 33–37 University Street, London WC1E 6JN

Tel 0300 012 0275 (Mon–Fri, 10am–4pm)

Email info@changingfaces.org.uk

www.changingfaces.org.uk

Offers support and information to people who have any sort of disfigurement, and their family and friends. Has skin camouflage practitioners in locations across the UK – to find your local centre, visit changingfaces.org.uk/skin-camouflage/clinic-venues

Cancer information and support

Cancer Black Care

79 Acton Lane, London NW10 8UT

Tel 020 8961 4151

Email info@cancerblackcare.org.uk

www.cancerblackcare.org.uk

Offers information and support for people with cancer from ethnic communities, their friends, carers and families.

Cancer Focus Northern Ireland

40–44 Eglantine Avenue, Belfast BT9 6DX

Helpline 0800 783 3339 (Mon–Fri, 9am–1pm)

Email helpline@cancerfocusni.org

www.cancerfocusni.org

Offers a variety of services to people affected by cancer, including a free helpline, counselling and links to local support groups.

Cancer Support Scotland

Cancer Support Scotland Centre,75 Shelley Road, Glasgow G12 0ZE

Tel 0800 652 4531 (Mon–Fri, 9am–5pm)

Email info@cancersupportscotland.org

www.cancersupportscotland.org

Runs cancer support groups throughout Scotland. Also offers free complementary therapies and counselling to anyone affected by cancer.

Irish Cancer Society

43–45 Northumberland Road, Dublin D04 VX65

Helpline 1800 200 700 (Mon–Thu, 9am–4pm)

Email cancernurseline@irishcancer.ie

www.cancer.ie

Offers information, support and care to people affected by cancer. You can talk to a nurse on the phone or online.

Maggie’s Centres

The Gatehouse, 10 Dumbarton Road, Glasgow G11 6PA

Tel 0300 123 1801

Email enquiries@maggiescentres.org

www.maggiescentres.org

Has a network of centres in various locations throughout the UK. Provides free information about cancer and financial benefits. Also offers emotional and social support to people with cancer, their family, and friends.

Tenovus

Gleider House, Ty Glas Road, Cardiff CF14 5BD

Helpline 0808 808 1010 (Daily, 8am–8pm)

Email info@tenovuscancercare.org.uk

www.tenovuscancercare.org.uk

Aims to help everyone get equal access to cancer treatment and support. Funds research and provides support such as mobile cancer support units, a free helpline, an ‘Ask the nurse’ service on the website and benefits advice.

Counselling and emotional support

British Association for Counselling and Psychotherapy (BACP)

BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire LE17 4HB

Tel 01455 883 300

Email bacp@bacp.co.uk

www.bacp.co.uk

Promotes awareness of counselling and signposts people to appropriate services. You can search for a qualified counsellor at itsgoodtotalk.org.uk

UK Council for Psychotherapy (UKCP)

2nd Floor, Edward House, 2 Wakley Street, London EC1V 7LT

Tel 020 7014 9955

Email info@ukcp.org.uk

www.psychotherapy.org.uk

Holds the national register of psychotherapists and psychotherapeutic counsellors, listing practitioners who meet exacting standards and training requirements.

Financial or legal advice and information

Citizens Advice

Provides advice on a variety of issues including financial, legal, housing and employment issues. Find details for your local office in the phone book or on one of these websites:

England

www.citizensadvice.org.uk

Wales

www.citizensadvice.org.uk/wales

Scotland

www.cas.org.uk

Northern Ireland

www.citizensadvice.co.uk

You can also find advice online in a range of languages at www.citizensadvice.org.uk/resources-and-tools/languages

Department for Work and Pensions (DWP)

Personal Independence Payment (PIP) Helpline 0345 850 3322

Textphone 0345 601 6677 (Mon–Fri, 8am–6pm)

Carer’s Allowance Unit

Tel 0345 608 4321

Textphone 0345 604 5312 (Mon–Thurs, 8.30am–5pm, Fri, 8.30am to 4.30pm)

www.gov.uk/browse/benefits

Manages state benefits in England, Scotland and Wales. You can apply for benefits and find information online or through its helplines.

GOV.UK

www.gov.uk

Has information about social security benefits and public services in England, Scotland and Wales.

Personal Finance Society – ‘Find an Adviser’ service

www.thepfs.org/yourmoney/find-an-adviser

Use the website to find qualified financial advisers in your area.

Disclaimer, thanks and sources

Disclaimer

We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Some photos are of models.

Thanks

This ebook has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by our Senior Medical Editor, Dr James Larkin, Consultant Medical Oncologist, and by our Chief Medical Editor, Dr Tim Iveson, Macmillan Consultant Medical Oncologist.

With thanks to: Dr Veronique Bataille, Consultant Dermatologist; Ruth Devlin, Lead Skin Cancer Clinical Nurse Specialist; Ann Irwin, Clinical Nurse Specialist Skin Cancer; and Professor Barry Powell, Consultant Plastic Surgeon.

Thanks also to the people affected by cancer who reviewed this edition, and to those who shared their stories.

Sources

We’ve listed a sample of the sources used in this publication below. If you’d like further information about the sources we use, please contact us at bookletfeedback@macmillan.org.uk

Dummer, et al. Cutaneous melanoma. ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2015.

Marsden, et al. Revised UK guidelines for the management of cutaneous melanoma. British Journal of Dermatology. 2010.

National Comprehensive Cancer Network (NCCN). Melanoma NCCN Evidence Blocks, Version 2. Clinical Practice Guidelines in Oncology. 2016.

National Institute for Health and Care Excellence (NICE). Melanoma: assessment and management. 2015.

Ribas, et al. Cutaneous Melanoma. Devita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th edition. Lippincott Williams & Wilkins. 2015.

UpToDate. www.uptodate.com (accessed April 2016).

Can you do something to help?

We hope this ebook has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.

We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.

Share your cancer experience

Support people living with cancer by telling your story, online, in the media or face to face.

Campaign for change

We need your help to make sure everyone gets the right support. Take an action, big or small, for better cancer care.

Help someone in your community

A lift to an appointment. Help with the shopping. Or just a cup of tea and a chat. Could you lend a hand?

Raise money

Whatever you like doing you can raise money to help. Take part in one of our events or create your own.

Give money

Big or small, every penny helps.

Call us to find out more 0300 1000 200

macmillan.org.uk/getinvolved