Principles

NHS Long-Term Plan commits to:
- Stratified follow-up pathways.
- Holistic Needs Assessment (HNA) at end-of-treatment and annually.
- Treatment Summary shared with primary care.
- Cancer Care Review (CCR) by GP.
- Personalised follow-up planning (Macmillan Recovery Package).
Stratified by recurrence risk:
- Low-risk: PIFU (Patient-Initiated Follow-Up) or annual review.
- Moderate-risk: structured nurse-led follow-up.
- High-risk: consultant-led + imaging surveillance.

Components of survivorship clinic

Recurrence surveillance:
- Clinical examination — primary site, regional nodes, full skin.
- Imaging per stage and BAD / NICE guidelines.
- Photography / mole-mapping for high-risk patients.
Secondary prevention:
- Photoprotection counselling — sunscreen, clothing, UV avoidance.
- Self-skin examination education.
- Acitretin chemoprophylaxis in transplant / multiple cSCC.
- Vitamin D status assessment.
- Counsel about increased second-primary melanoma risk, commonly around 5-10% over longer follow-up but higher in familial, multiple-primary, high-naevus-burden or other high-risk cohorts; keratinocyte cancer risk is also increased.
Late-effect management:
- Scar care, lymphoedema surveillance.
- Cancer-related fatigue.
- ICI long-term sequelae (thyroid, hypophysitis, vitiligo).
- Radiation late effects.
- Cognitive and mood sequelae.
Psychosocial:
- HADS or PHQ-9 screening.
- Sexual health, fertility.
- Body image, return-to-work, financial.
- Macmillan / Maggie's / charity signposting.
Holistic Needs Assessment (HNA): structured proforma covering physical, emotional, practical, spiritual, family.
Care plan: agreed personalised summary shared with patient + GP.

Note: Source-checked against NICE NG14 melanoma, BAD cSCC and BAD BCC guidance (16 May 2026). Always verify against current local protocol.

Melanoma (NICE NG14):
- Stage IA: follow-up for ~1 year (about 2 visits), then discharge with safety-netting; no routine surveillance imaging (per NICE NG14, 2022 update).
- Stage IB-IIA: every 3-6 months for 3 years; 6-12 months years 4-5.
- Stage IIB-IIIA: every 3 months for 3 years; 6 months years 4-5; imaging surveillance.
- Stage IIIB-IV: tailored intensive surveillance with imaging.
cSCC (BAD 2020):
- Low-risk: PIFU or annual review for 2 years.
- High-risk: every 3-6 months for 2 years; annual to 5 years.
BCC (BAD 2021):
- Low-risk: discharge to GP / PIFU after histological confirmation.
- High-risk / recurrent / Mohs: nurse-led 12-monthly for 3-5 years.

National Cancer Audit and Analysis (NCAA): outcome reporting.
Patient-Reported Outcome Measures (PROMs): EORTC QLQ-C30, FACT-Melanoma, EQ-5D-5L.
Patient-Reported Experience Measures (PREMs): National Cancer Patient Experience Survey.
Cancer Quality of Life Survey (NHSE).
Macmillan Living With and Beyond Cancer (LWBC) framework.
Skin-cancer-specific PROMs / surveys.
Regular audit of recurrence detection rate, time-to-detection, PIFU activation rate.