Jackie Hodgetts is a Nurse Clinician at The Christie Hospital in Manchester, and a Trustee of charity Melanoma Focus. In 2009 she completed a Master’s degree in Clinical Practice, and since then has worked with melanoma patients, assessing and supporting them through treatment, as well as managing their toxicities. In this week’s Real Voices, she describes the reality for patients of living with this deadly disease, as well as the signs of melanoma to look out for.

I’ve worked at the Christie Hospital in Manchester for 30 years, and I started there as a research nurse working with lung cancer patients. We also had a very small melanoma clinic, and I found that I really loved working with melanoma patients. I did a Master’s Degree in 2007 to become an Advanced Practitioner in Health and Social Care. At that time, we were doing a lot of trials in melanoma as there weren’t any effective treatments for it yet. I agreed to help, provided that I could exclusively work with melanoma patients. I just found it a very interesting cancer, and I loved all of the melanoma patients in the clinic. At the time, the prognosis for melanoma patients was very poor, with median survival being about 6 months for someone with metastatic disease.

Treatments for melanoma came along very suddenly about a decade ago. Immunotherapy and targeted therapies were both developed, which are very effective and completely changed the game for melanoma patients. So from the median survival being 6 months in 2007, it changed so that now 90% of patients survive at least five years on from the point of diagnosis. It’s made a spectacular difference, but it has brought many challenges with it. We have more patients as they’re staying with us, rather than passing away, so the workload has increased significantly. The clinics are getting bigger and bigger, and we’re now giving preventative treatment which reduces the risk of recurrence by about 50%.

My role is to see new patients and assess their suitability for treatments. We go into a lot of detail about the side effects of different treatments, and it’s a lot for a new patient to understand. I then stay in contact with the patient after they begin treatment, checking in with them regularly about how it’s going, organising their scans, liaising with them about results, and deciding when to go onto next steps. My job has changed a lot since these treatments were introduced. We used to give melanoma patients chemotherapy before we had the new treatments, but this only had about a 1 in 5 chance of working, and even then it didn’t improve survival. The one upside to chemotherapy is that it doesn’t have that many side effects. The new treatments that we use now for melanoma patients have a lot of different side effects, which has meant that I’ve had to learn all about several new spheres of medicine, because these side effects can affect any organ. It’s definitely been a challenge.

The main signs of melanoma to look out for are any changes to moles. If you have a mole that becomes darker, or crusted, or itchy, or bleeds, you must seek advice from a GP. Here is an ABCDE scale for checking your moles:

• A stands for Assymetry. If one half of the mole is different from the other half, this can indicate melanoma.
• B stands for Borders. If the spot has an irregular, scalloped, or poorly defined border.
• C stands for Color. If the spot has varying colours from one area to the next, such as shades of blue or black, or areas of white and red. 
• D stands for Diameter. If the mole is bigger than 6mm (about the size of the end of a pencil). 
• E is for Evolving. If the mole is different from the others or is changing size, shape, border or colour. 

People with abnormal moles may often go to the GP and be reassured, but even if they’ve done that they should keep an eye on the mole and take regular pictures of it. If they’re still concerned, they should go back to the doctor and insist on an appointment with a dermatologist. If you do get diagnosed with melanoma, it will be reassuring to know that around 80% of melanomas are cured by surgery, and won’t cause any further issues going forward. 20% will metastisize, and the difficulty is that after treatment someone could essentially be cancer-free but still have a relative risk of the melanoma returning. Some of the patients we deem at high risk need to go through a year of preventative treatment. 

As a Trustee of the charity Melanoma Focus, I am one of seven nurses who run their helpline. All of the nurses are highly experienced with melanoma patients and have a deep understanding of this disease. We get all sorts of calls from people worried about moles, and whilst we can’t diagnose over the phone, we can signpost them to the GP and help them to know what to say and how to describe the problem properly. We also get calls from patients who are recently diagnosed, and want information and reassurance. I speak to people who have had their treatment options from a specialist and want a second opinion or some independent advice. Sometimes metastatic patients call us regularly just to talk through their worries.

I would urge people to pay attention to their moles and look out for signs, following the ABCDE checks as detailed above. Especially in the wake of the pandemic, many worry about bothering the GP over nothing, but it is so important to make sure. If you are even a little bit concerned, please do not hesitate to go to the doctor.