A study looking at why melanoma skin cancer comes back after surgery

Cancer type:

Skin cancer





This study looked at the lifestyle of people who have had surgery to remove their melanoma. And about how to identify people most likely to be anxious so that healthcare teams can offer appropriate support.

More about this trial

Doctors usually treat melanoma with surgery. To decide the chance of the melanoma coming back after surgery they look at:
  • how deep the melanoma is
  • what the melanoma cells are like under a microscope
The doctors then class the melanoma as low, medium or high risk. For low risk melanoma there is very little chance that the cancer will come back. So you are unlikely to have further treatment.
For melanoma that is medium risk or high risk you might have treatment such as immunotherapy or chemotherapy after surgery.
In this study the research team looked at the lifestyle factors of people:
  • with medium risk melanoma
  • with high risk melanoma
  • with a rare melanoma (in body sites not usually exposed to the sun such as the sole of the foot)
  • who have had a sentinel node biopsy
The main aim of this study was to identify what lifestyle factors and genetic factors could affect the chance of melanoma coming back after surgery.

Summary of results

The team have identified lifestyle factors and genetic factors that could affect the chances of people’s melanoma coming back after surgery.
About this study
More than 2,000 people took part in this study. 
They completed a questionnaire. The questions asked were about:
  • their medical history and their family’s medical history
  • lifestyle such as their diet, if they smoked and how much alcohol they drank
  • stress, significant life events and how they dealt with them
The study team took blood samples. 
They also looked at the sample of tissue (biopsy Open a glossary item) from these people that was taken when they were diagnosed.  
They looked at medical records to find out: 
  • what the melanoma was like at diagnosis
  • how long people lived after treatment
They also used the national cancer registers Open a glossary item to find out how long people lived after treatment. 
Vitamin D
In 2015 the study team published results about the amount of vitamin D in the blood when people were diagnosed with melanoma. They also looked at:
  • if they smoked
  • had diabetes
  • the medication they took
  • their body mass index Open a glossary item (BMI)
They found that increasing the amount of vitamin D might decrease the chance of dying from melanoma. And that smoking increased the risk of dying from melanoma.
Inflammation and ulceration
In 2015 the team also published results about inflammation and when the melanoma had developed a wound (ulcer). This is called ulceration.
Researchers looked at 348 samples of tissue taken from people whose melanoma was ulcerated at diagnosis. 
Ulceration is linked to a poor outcome after treatment. But having interferon after initial treatment seems to improve the outcome. Researchers wanted to find out why this might be. 
They found that ulcerated melanomas had greater numbers of macrophages Open a glossary item, a type of white blood cell. And that certain genes were involved in the inflammation. 
This suggested that certain pathways of the immune system Open a glossary item are involved in inflammation of melanoma. And this particular type of inflammation was harmful.  
The team believed that interferon changed the signals of these pathways. And this is what improved the outcome. 
Worrying about having melanoma
In 2016 the team published the results of the questionnaire that was completed by 2,088 people. 
In response to the question about their future after melanoma:
  • 1,568 people (75%) reported feeling confident about their future
  • 520 people (25%) reported feeling worried about their future
People who reported being more worried about their future were:
  • women
  • young people
  • people with melanoma that had spread
  • people who felt that they had received no or poor support from their healthcare team
  • people who felt they weren’t well informed 
  • people who were stressed at work or unemployed
  • people who had money worries
  • people who had more than 1 negative life experience in the past 5 years
  • people whose melanoma developed in an area protected from the sun
The study team identified a number of life factors that affect how worried people are after a diagnosis and treatment of melanoma.  
In 2018 the team published results about the number of immune cells,
the genes Open a glossary item in melanoma tumours that had a change (mutation Open a glossary item) and how long people lived. 
The team did a detailed study of 703 melanoma tissues samples. They looked for evidence of how many and the type of immune cells in each sample. Based on this they gave each sample an immune score. They identified 6 sub groups. 
Researchers looked at how long people in each sub group lived. They found that the higher the immune score the longer people lived after treatment.
The immune score was less protective in people whose melanoma had the gene change (mutation) in the NRAS gene. 
The team found there was a link between genetic factors and how the immune system responded to the melanoma. 
This suggests that taking into account these factors will improve how well we can predict benefit from immunotherapy treatment.
The study team identified lifestyle factors and genetic factors that could affect the chances of melanoma coming back after surgery.
Researchers are continuing to look at these tissue samples to find out more about:
  • melanoma
  • treatment for melanoma
  • what affects the outcome of treatment
Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Julia Newton Bishop

Supported by

Cancer Research UK
EU under Framework 6
NIHR Clinical Research Network: Cancer
National Institutes of Health (NIH)


If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Last reviewed:

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