This article critically evaluates the practice of follow-up for patients who have undergone treatment for a primary melanoma without evidence of metastases. One conclusion from this analysis is that the benefits of routine imaging and blood testing are insufficient to warrant a place in routine follow-up. Few patients who have metastases are identified in this fashion and even fewer survive because they underwent these tests. Far more often, false-positive results occur, which invariably cause unnecessary concern, lead to additional unnecessary testing, and may even result in needless surgery. Based on the evidence available, the relevance of follow-up per se must even be challenged. No convincing evidence exists that regional control, survival, and quality of life improve through surveillance. Other reasons for surveillance may be present, but these are less imperative. The present findings challenge current practice.