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Melanoma Monitoring and Progress Chart

Patient Self-Monitoring Tool for Skin Cancer Follow-up

Oncology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _____________________
Date of Diagnosis: //___
Treating Physician: _____________________

Regular Self-Examination Record

Monthly Skin Check

Date New Spots Changes in Existing Spots Actions Taken

ABCDE Monitoring Guidelines

  • Asymmetry: Mark if spot is not even on both sides
  • Border: Note irregular, notched, or scalloped edges
  • Color: Document various colors (brown, black, red, blue)
  • Diameter: Measure size (larger than 6mm needs attention)
  • Evolving: Track any changes in size, shape, or color

Clinical Visits Schedule

Follow-up Appointments

  • Next scheduled visit: //___
  • Frequency of visits: □ 3 months □ 6 months □ Annually

Imaging Schedule

  • Next scheduled scan: //___
  • Type: □ CT □ PET □ MRI □ Other: _________

Treatment History

Date Treatment Type Response Side Effects

Emergency Contact Information

Oncologist: _____________________
Phone: _____________________
After Hours: _____________________

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