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    How to Manage Fear After Melanoma

    mole paranoia 2

    Nothing terrifies patients like the word “cancer.” Maybe that explains, at least to some degree, the undeniable trend I’ve noticed among my young female patients when they’re diagnosed with melanoma, a potentially-deadly form of skin cancer: Many of them develop a sudden, profound worry about virtually every last spot on their skin.

    “I started to feel paranoid, even about moles that had stayed the same since I was a kid,” says Amanda, who was treated for melanoma in her early 30’s. “After my cancer surgery, I went right back to the dermatologist and asked for two other moles to be biopsied. The results came back normal, but I couldn’t stop worrying until they were tested.” Another 20-something patient chose to have over a dozen spots removed (by other medical providers) because she needed reassurance that they were normal – at the cost of significant permanent scarring.

    If there’s any good news about this cycle of worry and doubt, it’s that patients can work their way out of it, and can begin to feel comfortable in their skin again. What may help:

    • Understand that melanoma isn’t a one-size-fits-all disease. Your doctor can guide you through your stage, prognosis, and what to expect. I don’t worry much about my patients with the earliest form of melanoma (called “melanoma in situ”) because it has about a 99% cure rate after surgery – we mainly need to watch for new skin cancers elsewhere. Melanoma that’s spread deeply into the skin, to the lymph nodes, or to other organs, on the other hand, can have a grave prognosis (metastatic disease has a 15 to 20% survival rate after 5 years, though this number is now climbing thanks to recently-developed targeted therapies).
    • Know that the odds of a second melanoma are low. A 2012 study in Cancer showed that only 4 to 8 percent of melanoma patients will someday develop another one. The risk is highest in those over 60, particularly within the first year of diagnosis.
    • See a board-certified dermatologist for a skin check regularly – every 3 to 6 months for at least a couple of years after a skin cancer diagnosis (the time between appointments lengthens as time passes). Your derm can scan your skin from head to toe, remove anything suspicious, point out spots that require monitoring (a dark mole that doesn’t have smooth edges, for example), and those that don’t (freckles, bright pink spots called cherry angiomas, normal growths called seborrheic keratoses). “Getting checked regularly has been the most helpful way to overcome my worry,” says Amanda. To find a board-certified dermatologist in your area visit find-a-derm.aad.org.
    • Reduce your risk with sun protection. “It makes me feel more in control to wear sunscreen every day, and to reapply every 2 hours, like I’m supposed to,” says Rachel, a 25-year-old patient. Hats, protective clothing, and avoiding peak sun hours and indoor tanning can lower the chances of another skin cancer, too.
    • Check yourself. I often tell my patients that if there’s anything good about melanoma, it’s that it’s right there on the skin for us to see, treat, and cure. That’s why it helps to pay attention to your moles, and learn the ABCDEs of melanoma so you know some of the warning signs (this website is a great resource).
    • Take photos of prominent spots to monitor for change (some people rely on apps, such as Mole Mapper). If you have 75 or more true moles on the skin (freckles don’t count), consider professional, high-resolution photographs to allow for careful inspection and comparison during derm visits.
    • Indulge in whatever makes you feel good: Massage. Meditation. Music. Exercise. Friends. Family. Anything that shifts the focus away from your skin and onto the things that bring you happiness.
    • Identify something positive that’s come from your diagnosis. Research from Cancer Nursing in 2017 suggests this may help increase life satisfaction after melanoma. Perhaps it’s that the disease was caught early and cured. Maybe you no longer feel bothered by relatively trivial concerns. Or maybe you encouraged someone else to have a skin check.  
    • Don’t be afraid to seek a counselor’s help (it’s normal to want or need this), like through the Cancer Support Community Helpline: 888-793-9355.
    • Reach out. “It helped me so much to talk about my diagnosis with friends, and to go on Facebook or online to connect with other young women who’ve had melanoma,” Rachel says. “You learn that you’re not the only one going through this and you’re going to get through it.”

    ​[Please note that the women who volunteered their comments for this story are my patients. Their names and identifying details have been changed for confidentiality.]

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