Just diagnosed with Melanoma — what should I do first

First Steps After a Melanoma Diagnosis

I'm sorry you're facing this diagnosis. The good news is that melanoma is curable, especially when caught early—in fact, more than 3 in 4 melanomas are found before they've spread, making them easier to treat.

Here's what you should focus on right now:

1. Understand Your Specific Situation

Your care team will determine your melanoma's stage—essentially how far it has progressed. According to the NCCN Guidelines for Patients: Melanoma, staging happens in two phases:

• After biopsy (initial testing of the suspicious spot)
• After surgery (which often reveals more detailed information)

The stage ranges from 0 (earliest) to 4 (spread to distant areas). Your stage will guide all treatment decisions, so understanding it is crucial.

Questions to ask your doctor:

• What is my melanoma's stage?
• How deep has it grown into my skin (Breslow thickness)?
• Have any lymph nodes been affected?
• Do I need additional testing (imaging, genetic testing)?

2. Get Complete Surgical Evaluation

For most melanomas, surgery is the primary treatment. Your dermatologist or surgical oncologist will discuss removing the melanoma with adequate margins (surrounding healthy skin) to ensure complete removal.

Ask about:

• What type of surgery is recommended for my specific melanoma?
• Will I need a sentinel lymph node biopsy (a procedure to check if cancer has spread to nearby lymph nodes)?
• What will the scar look like, and where will it be?

3. Ask About Biomarker Testing

Your pathology report should include testing for specific genetic mutations, particularly BRAF mutations. According to NCCN Guidelines, this testing helps determine which treatment options may work best for you if additional therapy is needed beyond surgery.

Ask your doctor:

• Was my melanoma tested for BRAF mutations?
• What other biomarkers were tested?
• How do these results affect my treatment options?

4. Understand Your Treatment Options

Based on your stage, treatment may include:

Early-stage melanoma (stages 0-2): Usually surgery alone is sufficient.

Regional melanoma (stage 3): Surgery plus potentially:

• Immunotherapy (drugs that help your immune system fight cancer)—such as nivolumab or pembrolizumab
• T-VEC (intralesional therapy—injections directly into melanoma lesions)
• Targeted therapy (if you have a BRAF mutation)
• Observation (careful monitoring without additional treatment)

Metastatic melanoma (stage 4): Multiple systemic therapy options exist, which your oncologist will discuss.

5. Build Your Care Team

You'll likely need:

• A dermatologist (skin specialist) or surgical oncologist (cancer surgeon)
• An oncologist (cancer specialist) if additional treatment is needed
• Possibly a medical geneticist if genetic testing is recommended

Consider seeking care at an NCCN Cancer Center if possible—these are leading institutions with melanoma expertise.

6. **Gather Your [ID removed]

Request copies of:

• Your biopsy pathology report
• Any imaging results (CT scans, PET scans, etc.)
• Genetic testing results
• Surgical reports

Having these organized helps any specialist quickly understand your situation.

7. Take Care of Yourself

While you're navigating medical decisions:

• Write down questions before appointments
• Bring a trusted person to appointments to help you listen and take notes
• Don't rush major decisions—ask about timeline
• Look into support resources (see below)

Important Resources

According to the NCCN Guidelines, these organizations provide melanoma-specific support:

• Melanoma Research Foundation (melanoma.org)
• AIM at Melanoma (AIMatMelanoma.org)
• The Skin Cancer Foundation (skincancer.org)
• American Cancer Society (cancer.org)

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Key Takeaway

Your immediate priority is understanding your stage and getting a complete surgical evaluation. Everything else—whether you need additional treatment, what type, and how to monitor going forward—flows from that foundation.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.