What are the primary causes of metastatic melanoma. How can you recognize the symptoms of advanced skin cancer. What treatment options are available for stage IV melanoma. How does metastatic melanoma impact quality of life. What support systems are crucial for patients with metastatic melanoma.

Understanding Metastatic Melanoma: A Deep Dive into Advanced Skin Cancer

Metastatic melanoma, also known as stage IV melanoma, is an advanced form of skin cancer that has spread beyond its original site to other parts of the body. This condition poses significant challenges for patients and healthcare providers alike, requiring a comprehensive approach to treatment and management.

What Defines Metastatic Melanoma?

Metastatic melanoma occurs when cancer cells from the original melanoma site travel through the bloodstream or lymphatic system to establish new tumor growths in distant organs or tissues. Common sites for melanoma metastasis include:

• Subcutaneous tissue
• Lymph nodes
• Lungs
• Liver
• Brain

While metastatic melanoma is often considered incurable, advancements in medical science have led to improved treatment options and increased survival rates for patients.

Unraveling the Causes of Metastatic Melanoma

Understanding the root causes of metastatic melanoma is crucial for both prevention and treatment strategies. The primary culprit behind this aggressive form of skin cancer is exposure to ultraviolet (UV) radiation, which can damage the DNA of skin cells, leading to uncontrolled growth and spread.

What are the main sources of harmful UV radiation?

The two primary sources of UV radiation that contribute to melanoma development are:

1. Sun exposure: Prolonged or intense exposure to natural sunlight
2. Artificial tanning: Use of tanning beds or sunlamps

It’s important to note that melanoma can also develop in areas of the body that receive little to no sun exposure, such as the palms of the hands or the retinas of the eyes. This suggests that other factors may play a role in the development and progression of the disease.

Risk Factors for Metastatic Melanoma

Several factors can increase an individual’s likelihood of developing metastatic melanoma:

• Fair skin, light hair, and light eye color
• Presence of numerous moles or irregular moles
• Family history of melanoma
• Previous diagnosis of melanoma
• Weakened immune system
• Advanced age

Identifying these risk factors can help individuals and healthcare providers take proactive measures to prevent melanoma or detect it early, potentially preventing metastasis.

Recognizing the Symptoms of Metastatic Melanoma

Early detection of metastatic melanoma is crucial for improving treatment outcomes. As the cancer spreads to different parts of the body, it can manifest various symptoms depending on the affected organs.

What are the common signs of metastatic melanoma?

Patients with metastatic melanoma may experience a range of symptoms, including:

• Hardened lumps under the skin
• Swollen or painful lymph nodes
• Persistent cough or difficulty breathing
• Liver swelling or loss of appetite
• Bone pain or unexplained fractures
• Headaches, seizures, or neurological symptoms
• Unexplained weight loss
• Chronic fatigue

It’s important to note that these symptoms can also be indicative of other health conditions. Therefore, a thorough medical evaluation is necessary for an accurate diagnosis.

Diagnostic Approaches for Metastatic Melanoma

Diagnosing metastatic melanoma involves a multi-step process that combines physical examinations, medical history reviews, and various diagnostic tests. This comprehensive approach helps healthcare providers accurately assess the extent of the disease and develop appropriate treatment plans.

What is the typical diagnostic process for metastatic melanoma?

The diagnostic journey for metastatic melanoma often includes:

1. Medical history review: Assessing risk factors and previous melanoma diagnoses
2. Physical examination: Thorough skin and lymph node examination
3. Biopsy: Removal and analysis of suspicious tissue samples
4. Blood tests: Checking for specific markers and overall health status
5. Imaging studies: Utilizing various techniques to detect metastases

Types of Biopsies for Melanoma Diagnosis

Several biopsy techniques may be employed to diagnose melanoma:

• Punch biopsy: Removal of a small, round piece of skin
• Excisional biopsy: Complete removal of the suspicious growth
• Shave biopsy: Shaving off the surface of the growth

The choice of biopsy technique depends on the size, location, and characteristics of the suspicious lesion.

Advanced Imaging Techniques for Metastasis Detection

To identify metastases throughout the body, healthcare providers may utilize various imaging technologies:

• Chest X-ray: Basic imaging for lung metastases
• CT scan: Detailed cross-sectional images of internal organs
• MRI: High-resolution imaging using magnetic fields and radio waves
• PET scan: Functional imaging to detect active cancer cells

These imaging studies help determine the stage of the cancer and guide treatment decisions.

Navigating Treatment Options for Metastatic Melanoma

While metastatic melanoma presents significant treatment challenges, recent advancements have expanded the available options and improved patient outcomes. The choice of treatment depends on various factors, including the extent of metastasis, the patient’s overall health, and individual preferences.

What are the primary treatment modalities for metastatic melanoma?

Treatment approaches for metastatic melanoma may include:

1. Immunotherapy: Enhancing the body’s immune response against cancer cells
2. Targeted therapy: Using drugs that target specific genetic mutations in melanoma cells
3. Chemotherapy: Employing drugs to kill cancer cells throughout the body
4. Radiation therapy: Using high-energy beams to shrink tumors and alleviate symptoms
5. Surgery: Removing metastatic tumors when feasible
6. Combination therapies: Utilizing multiple treatment modalities for enhanced efficacy

Immunotherapy: Harnessing the Power of the Immune System

Immunotherapy has revolutionized the treatment of metastatic melanoma. This approach works by stimulating the patient’s immune system to recognize and attack cancer cells more effectively. Common immunotherapy agents include:

• Checkpoint inhibitors (e.g., pembrolizumab, nivolumab)
• CTLA-4 inhibitors (e.g., ipilimumab)
• Cytokines (e.g., interleukin-2)

These treatments have shown remarkable success in some patients, leading to long-term remissions and improved survival rates.

Targeted Therapies: Precision Medicine for Melanoma

Targeted therapies focus on specific genetic mutations that drive melanoma growth. These treatments are particularly effective in patients with BRAF mutations, which occur in approximately 50% of melanomas. Common targeted therapies include:

• BRAF inhibitors (e.g., vemurafenib, dabrafenib)
• MEK inhibitors (e.g., trametinib, cobimetinib)
• Combination BRAF/MEK inhibitor therapies

These drugs can rapidly shrink tumors and provide significant symptom relief in responsive patients.

Managing Side Effects and Improving Quality of Life

While treatments for metastatic melanoma can be effective, they often come with side effects that can impact a patient’s quality of life. Managing these side effects is crucial for maintaining treatment adherence and overall well-being.

How can patients cope with treatment-related side effects?

Strategies for managing side effects may include:

• Open communication with healthcare providers about symptoms
• Medication adjustments or supportive therapies
• Lifestyle modifications, including diet and exercise
• Complementary therapies, such as acupuncture or massage
• Psychological support and counseling

Patients should work closely with their healthcare team to develop a personalized side effect management plan.

Palliative Care: Enhancing Quality of Life

Palliative care plays a vital role in the management of metastatic melanoma. This approach focuses on:

• Pain management
• Symptom control
• Emotional and psychological support
• Improving overall quality of life

Incorporating palliative care early in the treatment process can lead to better outcomes and improved patient satisfaction.

The Importance of Support Systems and Patient Empowerment

Coping with metastatic melanoma extends beyond medical treatments. A strong support system and patient empowerment are crucial components of comprehensive care.

How can patients build an effective support network?

Strategies for developing a robust support system include:

• Engaging family members and friends in the care process
• Joining support groups or online communities
• Seeking counseling or therapy services
• Connecting with patient advocacy organizations
• Utilizing hospital or clinic-based support services

A strong support network can provide emotional comfort, practical assistance, and valuable information throughout the treatment journey.

Patient Empowerment: Taking Control of Your Care

Empowering patients to actively participate in their care can lead to improved outcomes and satisfaction. Key aspects of patient empowerment include:

• Education about the disease and treatment options
• Shared decision-making with healthcare providers
• Self-advocacy and assertive communication
• Participation in clinical trials, when appropriate
• Setting realistic goals and expectations

By taking an active role in their care, patients can feel more in control and better equipped to navigate the challenges of metastatic melanoma.

Emerging Treatments and Future Directions in Metastatic Melanoma Care

The landscape of metastatic melanoma treatment continues to evolve rapidly, with ongoing research and clinical trials exploring new therapeutic approaches. These advancements offer hope for improved outcomes and potentially curative treatments in the future.

What are some promising areas of research in metastatic melanoma?

Cutting-edge research in metastatic melanoma includes:

• Novel immunotherapy combinations
• Personalized cancer vaccines
• Adoptive cell therapies, such as CAR-T cells
• Targeting of new molecular pathways
• Improved imaging techniques for early detection and monitoring
• Artificial intelligence-driven treatment selection

Patients should discuss the possibility of participating in clinical trials with their healthcare providers, as these studies may offer access to innovative treatments not yet widely available.

The Role of Precision Medicine in Metastatic Melanoma

Precision medicine, which tailors treatment to an individual’s genetic profile and specific disease characteristics, is increasingly important in metastatic melanoma care. This approach involves:

• Comprehensive genetic testing of tumor samples
• Liquid biopsies to monitor disease progression and treatment response
• Predictive biomarkers to guide treatment selection
• Individualized treatment plans based on molecular profiling

As our understanding of melanoma biology deepens, precision medicine approaches are likely to become even more refined and effective.

In conclusion, while metastatic melanoma remains a formidable challenge, the landscape of treatment and care continues to improve. With ongoing advancements in medical science, supportive care, and patient empowerment, individuals facing this diagnosis can approach their journey with hope and a comprehensive plan for managing their condition. By staying informed, actively participating in their care, and leveraging available support systems, patients with metastatic melanoma can optimize their quality of life and treatment outcomes.

Metastatic Melanoma: Causes, Symptoms, and Treatment

Written by Camille Peri

• What Is Metastatic Melanoma?
• Causes
• Symptoms
• Getting a Diagnosis
• Questions for Your Doctor
• Treatment
• Taking Care of Yourself
• What to Expect
• Get Support
• What Your Doctor Is Reading
• More

Melanoma is a type of skin cancer. When it spreads to other places in your body, it’s called metastatic, or advanced. You may also hear your doctor refer to it as stage IV melanoma.

Melanoma often spreads to:

• Tissue under the skin
• Lymph nodes
• Lungs
• Liver
• Brain

Although in many cases metastatic melanoma can’t be cured, treatments and support can help you live longer and better. Doctors have therapies that have greatly increased survival rates. And researchers are working to find new medications that can do even more.

Remember: You still have control over the decisions you make about your treatment and your life. It’s important to have people you can talk to about your plans, your fears, and your feelings. So find support and learn about your treatment options. That will help you make the most of your life.

In most cases, melanoma is caused by exposure to ultraviolet (UV) radiation from the sun or tanning beds. It damages the DNA of your skin cells, and they start to grow out of control.

You can get the disease on parts of your body that don’t get sunlight, though, like the palms of your hands and the retinas of your eyes.

You’re more likely to get melanoma if you have:

• Fair skin, along with lighter hair and eye color
• Many moles or irregular moles 
• A family history of melanoma

If your melanoma has spread to other areas, you may have:

• Hardened lumps under your skin
• Swollen or painful lymph nodes
• Trouble breathing, or a cough that doesn’t go away
• Swelling of your liver (under your lower right ribs) or loss of appetite
• Bone pain or, less often, broken bones
• Headaches, seizures, or weakness or numbness in your arms or legs
• Weight loss
• Fatigue

Before you have any tests, your doctor will want to know:

• Why did you come in?
• What have you noticed, and when?
• How are you feeling?
• Have you been diagnosed with melanoma before?
• If so, how was it treated?
• Has anyone in your family had melanoma?
• Have you ever used a tanning bed?
• How many times have you had a sunburn?
• Do you wear sunscreen? When? And what type?

If you haven’t already been diagnosed with melanoma, your doctor will do a skin exam. If they think you may have skin cancer, you’ll need a biopsy to find out.

You usually get one of three types:

• Punch biopsy. This removes a round piece of skin.
• Excisional biopsy. Your doctor takes out the entire growth.
• Shave biopsy. Your doctor tries to shave off the entire growth.

A doctor will look at the growth under a microscope to see how thick it is. Usually, a thicker tumor means there is a higher risk the cancer will spread. 

If you’ve been diagnosed with melanoma, you may also have a blood test and an imaging test to see if it has spread to other areas.

There are different types of imaging tests:

• Chest X-ray. This uses radiation in low doses to make pictures of the inside of your body.
• CT scan (computerized tomography). It uses powerful X-rays so your doctor can get a detailed look at what’s going on inside you.
• MRI (magnetic resonance imaging). It uses powerful magnets and radio waves to make pictures of organs and structures inside your body. It helps show blood flow and can help locate cancer growths.
• PET scan. This test uses radioactive material to look for signs of cancer.

The doctor will also check to see if your lymph nodes are enlarged. Lymph nodes are bean-sized glands under the skin in your neck, underarms, and groin. The doctor uses a thin needle to remove a sample of cells. This is called a fine-needle aspiration biopsy.

The doctor may also do a lymph node biopsy. This removes the lymph nodes most likely to have cancer cells. In this test, the doctor injects a dye into the area where the potential cancer was. It spreads to the nearest lymph nodes, which are removed and tested. If these lymph nodes, called sentinel nodes, don’t have cancer, then it’s likely the cancer hasn’t spread.

The results of these tests help the doctor determine the stage of your cancer and how widespread it is.

You and your doctor will decide on the best treatment plan once you know that information.

• Should I have other tests before we decide on a treatment?
• What treatments do you recommend?
• What’s involved in these treatments? How will I feel?
• Will treatments prolong my life? 
• Will treatments improve the quality of my life?
• Will I have scars?
• Will I be able to work while I’m having the treatment?
• What happens if it doesn’t help?
• Can I take part in clinical trials?
• Do you have experience treating metastatic melanoma?

Although metastatic melanoma is not easy to treat, you do have options. Choosing what’s right for you will depend on where and how big the cancer is, what your health is like, and what your wishes are. Since most cases of metastatic melanoma can’t be cured, the goals of treatment are to:

• Shrink or stop the growth of the disease where it has spread.
• Stop it from spreading to new areas.
• Make you more comfortable.

Treatment used to be mainly radiation and chemotherapy. Now there are newer drugs available that can work better, studies show. Your treatment may include:

Surgery. Your doctor may remove tumors or lymph glands. Although surgery alone probably won’t cure the cancer, it can help you live longer and have fewer symptoms. Your doctor will likely also use one or more other treatments.

Radiation and chemotherapy. These can help some people, depending on the size and location of the cancer.

Immunotherapy. These drugs boost your immune system so it can better attack the cancer. You get immunotherapy through an IV or a shot in high doses. It can have serious side effects, but it can also shrink metastatic melanomas and help some people live longer. These drugs include:

• Ipilimumab (Yervoy): There are two uses for this drug. It can be given to individuals who have had surgery to remove melanoma in order to prevent the melanoma from coming back. It can also be used for late-stage melanoma that cannot be removed by surgery. Ipilimumab is often used in combination with a PD-1 inhibitor.
• Nivolumab (Opdivo), nivolumab- relatlimab-rmbw (Opdualag), and pembrolizumab (Keytruda) work by inhibiting the PD-1 protein on cells, which enables  the body’s immune system to attack melanoma tumors. Combination therapy with ipilimumab and either nivolumab, pembrolizumab, and nivolumab-relatlimab-rmbw has been shown to increase overall survival compared to treating with ipilimumab alone.
• Interferon-alpha and interleukin-2: These older drugs can help some people live longer.

Researchers are studying many other drugs that spur the immune system to fight melanoma.

Targeted therapy. This kind of treatment aims to kill cancer cells without harming healthy ones. They may work for people who have certain changes in genes. Because these treatments target the tumors, they may cause fewer side effects than chemotherapy or radiation.

Some drugs attack a gene called BRAF. About half the people who have melanoma have changes in this gene, which helps cancer cells grow. If you have a tumor with BRAF, these drugs may shrink it and extend your life. They include:

Other drugs block an enzyme called MEK. This enzyme is often overactive in some cancers. These drugs, working in combination with a BRAF inhibitor to attack cancer cells, seem to shrink tumors for a longer period of time:

• Binimetinib (Mektovi)
• Cobimetinib (Cotellic)
• Trametinib (Mekinist)

Hearing that your cancer has spread is scary, but a lot of research is underway to find new treatments. And there are treatments available to try to stop the disease from spreading, so you can live longer.

It’s important to have support and to talk about your fears and feelings, too. Your doctor can help you find a cancer support group.

These tips may help you feel better during melanoma treatment:

• If you lose your appetite, eat small amounts of food every 2 to 3 hours instead of bigger meals. A dietitian can give you other tips on nutrition and eating during your cancer treatment. Ask your doctor for a referral.
• Exercise can help you feel better overall and fight fatigue. But listen to your body, and balance rest and activity.
• Get the kind of emotional support that’s right for you. It could be from family, friends, your cancer support group, or a religious group.

Although stage IV melanoma is hard to treat, each case is different, and some people will respond very well to treatment. Talk to your doctor about all your options, and find out more about clinical trials to see if one is right for you.

The Melanoma Research Foundation has an online library of free support services, including an online patient community and a phone buddy program. And for more information on metastatic melanoma, go to the web site of the Skin Cancer Foundation.

If you are interested in more advanced reading on this topic, we’ve made content from our health professional site, Medscape, available to you on WebMD.

Learn More

Top Picks

Metastatic Melanoma: Causes, Symptoms, and Treatment

Written by Camille Peri

• What Is Metastatic Melanoma?
• Causes
• Symptoms
• Getting a Diagnosis
• Questions for Your Doctor
• Treatment
• Taking Care of Yourself
• What to Expect
• Get Support
• What Your Doctor Is Reading
• More

Melanoma is a type of skin cancer. When it spreads to other places in your body, it’s called metastatic, or advanced. You may also hear your doctor refer to it as stage IV melanoma.

Melanoma often spreads to:

• Tissue under the skin
• Lymph nodes
• Lungs
• Liver
• Brain

Although in many cases metastatic melanoma can’t be cured, treatments and support can help you live longer and better. Doctors have therapies that have greatly increased survival rates. And researchers are working to find new medications that can do even more.

Remember: You still have control over the decisions you make about your treatment and your life. It’s important to have people you can talk to about your plans, your fears, and your feelings. So find support and learn about your treatment options. That will help you make the most of your life.

In most cases, melanoma is caused by exposure to ultraviolet (UV) radiation from the sun or tanning beds. It damages the DNA of your skin cells, and they start to grow out of control.

You can get the disease on parts of your body that don’t get sunlight, though, like the palms of your hands and the retinas of your eyes.

You’re more likely to get melanoma if you have:

• Fair skin, along with lighter hair and eye color
• Many moles or irregular moles 
• A family history of melanoma

If your melanoma has spread to other areas, you may have:

• Hardened lumps under your skin
• Swollen or painful lymph nodes
• Trouble breathing, or a cough that doesn’t go away
• Swelling of your liver (under your lower right ribs) or loss of appetite
• Bone pain or, less often, broken bones
• Headaches, seizures, or weakness or numbness in your arms or legs
• Weight loss
• Fatigue

Before you have any tests, your doctor will want to know:

• Why did you come in?
• What have you noticed, and when?
• How are you feeling?
• Have you been diagnosed with melanoma before?
• If so, how was it treated?
• Has anyone in your family had melanoma?
• Have you ever used a tanning bed?
• How many times have you had a sunburn?
• Do you wear sunscreen? When? And what type?

If you haven’t already been diagnosed with melanoma, your doctor will do a skin exam. If they think you may have skin cancer, you’ll need a biopsy to find out.

You usually get one of three types:

• Punch biopsy. This removes a round piece of skin.
• Excisional biopsy. Your doctor takes out the entire growth.
• Shave biopsy. Your doctor tries to shave off the entire growth.

A doctor will look at the growth under a microscope to see how thick it is. Usually, a thicker tumor means there is a higher risk the cancer will spread. 

If you’ve been diagnosed with melanoma, you may also have a blood test and an imaging test to see if it has spread to other areas.

There are different types of imaging tests:

• Chest X-ray. This uses radiation in low doses to make pictures of the inside of your body.
• CT scan (computerized tomography). It uses powerful X-rays so your doctor can get a detailed look at what’s going on inside you.
• MRI (magnetic resonance imaging). It uses powerful magnets and radio waves to make pictures of organs and structures inside your body. It helps show blood flow and can help locate cancer growths.
• PET scan. This test uses radioactive material to look for signs of cancer.

The doctor will also check to see if your lymph nodes are enlarged. Lymph nodes are bean-sized glands under the skin in your neck, underarms, and groin. The doctor uses a thin needle to remove a sample of cells. This is called a fine-needle aspiration biopsy.

The doctor may also do a lymph node biopsy. This removes the lymph nodes most likely to have cancer cells. In this test, the doctor injects a dye into the area where the potential cancer was. It spreads to the nearest lymph nodes, which are removed and tested. If these lymph nodes, called sentinel nodes, don’t have cancer, then it’s likely the cancer hasn’t spread.

The results of these tests help the doctor determine the stage of your cancer and how widespread it is.

You and your doctor will decide on the best treatment plan once you know that information.

• Should I have other tests before we decide on a treatment?
• What treatments do you recommend?
• What’s involved in these treatments? How will I feel?
• Will treatments prolong my life? 
• Will treatments improve the quality of my life?
• Will I have scars?
• Will I be able to work while I’m having the treatment?
• What happens if it doesn’t help?
• Can I take part in clinical trials?
• Do you have experience treating metastatic melanoma?

Although metastatic melanoma is not easy to treat, you do have options. Choosing what’s right for you will depend on where and how big the cancer is, what your health is like, and what your wishes are. Since most cases of metastatic melanoma can’t be cured, the goals of treatment are to:

• Shrink or stop the growth of the disease where it has spread.
• Stop it from spreading to new areas.
• Make you more comfortable.

Treatment used to be mainly radiation and chemotherapy. Now there are newer drugs available that can work better, studies show. Your treatment may include:

Surgery. Your doctor may remove tumors or lymph glands. Although surgery alone probably won’t cure the cancer, it can help you live longer and have fewer symptoms. Your doctor will likely also use one or more other treatments.

Radiation and chemotherapy. These can help some people, depending on the size and location of the cancer.

Immunotherapy. These drugs boost your immune system so it can better attack the cancer. You get immunotherapy through an IV or a shot in high doses. It can have serious side effects, but it can also shrink metastatic melanomas and help some people live longer. These drugs include:

• Ipilimumab (Yervoy): There are two uses for this drug. It can be given to individuals who have had surgery to remove melanoma in order to prevent the melanoma from coming back. It can also be used for late-stage melanoma that cannot be removed by surgery. Ipilimumab is often used in combination with a PD-1 inhibitor.
• Nivolumab (Opdivo), nivolumab- relatlimab-rmbw (Opdualag), and pembrolizumab (Keytruda) work by inhibiting the PD-1 protein on cells, which enables  the body’s immune system to attack melanoma tumors. Combination therapy with ipilimumab and either nivolumab, pembrolizumab, and nivolumab-relatlimab-rmbw has been shown to increase overall survival compared to treating with ipilimumab alone.
• Interferon-alpha and interleukin-2: These older drugs can help some people live longer.

Researchers are studying many other drugs that spur the immune system to fight melanoma.

Targeted therapy. This kind of treatment aims to kill cancer cells without harming healthy ones. They may work for people who have certain changes in genes. Because these treatments target the tumors, they may cause fewer side effects than chemotherapy or radiation.

Some drugs attack a gene called BRAF. About half the people who have melanoma have changes in this gene, which helps cancer cells grow. If you have a tumor with BRAF, these drugs may shrink it and extend your life. They include:

Other drugs block an enzyme called MEK. This enzyme is often overactive in some cancers. These drugs, working in combination with a BRAF inhibitor to attack cancer cells, seem to shrink tumors for a longer period of time:

• Binimetinib (Mektovi)
• Cobimetinib (Cotellic)
• Trametinib (Mekinist)

Hearing that your cancer has spread is scary, but a lot of research is underway to find new treatments. And there are treatments available to try to stop the disease from spreading, so you can live longer.

It’s important to have support and to talk about your fears and feelings, too. Your doctor can help you find a cancer support group.

These tips may help you feel better during melanoma treatment:

• If you lose your appetite, eat small amounts of food every 2 to 3 hours instead of bigger meals. A dietitian can give you other tips on nutrition and eating during your cancer treatment. Ask your doctor for a referral.
• Exercise can help you feel better overall and fight fatigue. But listen to your body, and balance rest and activity.
• Get the kind of emotional support that’s right for you. It could be from family, friends, your cancer support group, or a religious group.

Although stage IV melanoma is hard to treat, each case is different, and some people will respond very well to treatment. Talk to your doctor about all your options, and find out more about clinical trials to see if one is right for you.

The Melanoma Research Foundation has an online library of free support services, including an online patient community and a phone buddy program. And for more information on metastatic melanoma, go to the web site of the Skin Cancer Foundation.

If you are interested in more advanced reading on this topic, we’ve made content from our health professional site, Medscape, available to you on WebMD.

Learn More

Top Picks

Melanoma metastases: symptoms, how metastases are manifested in melanoma, signs of melanoma with metastases

Melanoma is a malignant neoplasm that develops as a result of neoplastic transformation of melanocytes. Localization of the primary tumor process can be not only in the skin, but also in the mucous membranes of the digestive system, genital tract, choroid and other tissues.

Sentinel node melanoma metastasis 3.1 mm

In melanoma, as well as in other types of malignant neoplasms, there is a high probability of metastatic lesions of regional lymph nodes and other organs. Metastasis is a distant tumor focus that originated from atypical cells of the primary focus. Metastasis in melanoma is common, and in some cases, the growth of metastases is detected earlier than its original source.

The principle and ways of metastasis

The process of appearance of secondary foci of neoplasms is very complex and has not been fully studied. It is assumed that the cause of metastasis is a violation of the interaction between atypical cells of the primary tumor, the extracellular matrix and normal cells. Several proteolytic enzymes have been found that trigger the degradation of the extracellular matrix and improve the adhesion of cancer cells, which allows them to move around the body and invade any tissue. In the growth of secondary neoplasms, an important role is played by the vascular endothelial growth factor, which stimulates the formation of new vessels, which subsequently feed the tumor. The spread of melanoma metastases usually occurs through the lymphatic and blood vessels. Most often, secondary foci appear in the lymph nodes, skin and subcutaneous tissue, bones, liver, lungs, and brain.

Metastases of melanoma in the brain

The first signs of brain damage are neurological disorders that can be represented by different symptom complexes:

• Focal and cerebral symptoms, which are typically gradual onset and last for several weeks.
• Symptoms that mimic a stroke. They develop as a result of hemorrhage in the metastatic tissue or when a blood vessel is blocked by a metastatic embolus.
• Symptoms that mimic brain inflammation and vascular disease.

In practice, a combination of cerebral and focal symptoms is most often observed. Patients complain of headaches, nausea and vomiting, dizziness, impaired motor and cognitive functions, convulsions, vision changes. In severe cases, high intracranial pressure develops, which can cause compression of the brain and wedging it into the foramen magnum, which often leads to the death of the patient.

The most informative in the diagnosis of brain metastases is magnetic resonance imaging with contrast, which allows you to visualize brain structures and detect affected areas. In all cases, it is recommended to conduct an electroencephalogram to detect seizure activity. Additionally, an examination by an ophthalmologist is prescribed to diagnose changes in the fundus.

Metastases of melanoma in the skin

Foci of secondary tumors in the skin and subcutaneous tissue occur on average in 15% of cases. The development of skin metastases depends primarily on the size of the primary tumor, its location, the age of the patient, and other features. Melanoma metastases spread to the skin can be either lymphogenous or hematogenous.

There are several forms of secondary tumor foci: satellite, thromboembolic, nodular, erysipelas. Melanoma is characterized by single and multiple metastases, which are located both near the primary focus and away from it. Color, size, shape and texture can be varied. In view of such a variety of clinical manifestations, differential diagnosis is often required.

Melanoma metastases in the lungs, kidneys, bones, liver

Atypical cells from the primary tumor enter the lungs by the hematogenous route. For melanomas, the presence of large single metastatic nodes in the lungs is typical, in which the clinical symptoms are mild and usually non-specific. In advanced cases, pulmonary embolism may develop, which is manifested by severe shortness of breath and chest pain.

Kidney metastases also rarely present with a dramatic clinical presentation. More often, kidney function remains normal or there are minor abnormalities. A secondary focus is usually detected during a routine examination of a patient for melanoma. The primary symptoms of kidney involvement may be micro- and gross hematuria. In the later stages, there are pains in the side and abdomen, hypertension, and an increase in the level of calcium in the blood.

In addition, distant neoplasms in the bones often occur in melanoma, the symptoms of which are pain, pathological fractures and hypercalcemia. To diagnose bone metastases, scintigraphy, x-rays, computed or magnetic resonance imaging are used.

Liver metastases are especially common (up to 90% of cases) in choroidal melanoma. At the initial stages, there are no symptoms, but as the metastasis grows, signs of compression of the biliary tract appear. Patients complain of pain in the right hypochondrium, jaundice, lack of appetite, feeling of fullness. With a superficial location, a volumetric formation in the liver area is probed. Ultrasound, computed tomography and magnetic resonance imaging help in making a diagnosis.

Diagnosis and treatment of melanoma metastases

Scientists classify melanoma as one of the most malignant and aggressive tumors. it tends to quickly spread throughout the body. Therefore, when it is detected, additional studies are immediately carried out to identify metastases. At the outpatient stage, they are prescribed:

• Computed tomography of the chest organs.
• Computed tomography of the abdomen and pelvic organs with contrast.
• Bone scintigraphy.
• Ultrasound of regional lymph nodes and internal organs.
• MRI of the brain.
• Determination of the S-100 protein, a high level of which is characteristic of disseminated tumor processes.

Timely detection of metastases at an early stage of diagnosis can improve the prognosis for the course of the disease and determine the tactics of treatment.

Metastatic melanoma is treated in a combined way. Usually they resort to surgical removal of the primary neoplasm and regional lymph nodes, followed by the appointment of conservative treatment. Radiation therapy is used for secondary brain damage.

Removal of stage 0 skin melanoma can be performed on an outpatient basis. At stage I of the disease, an organ-preserving operation or a wide excision of the primary focus with removal of the lymph nodes is performed. At stages II and III, the primary tumor and lymph nodes are removed, and drug therapy is prescribed. In stage IV with distant metastases in any organ, treatment is individual and depends on the patient’s condition. Radiation, immunotherapy, surgical interventions are used. Alternative methods of surgery, such as radiofrequency ablation, can be used to remove solitary lesions in the liver.

Rehabilitation after treatment and prognosis

Restoration of the body after treatment of a malignant tumor is facilitated by good nutrition, giving up bad habits, the use of multivitamin preparations, antioxidants, etc. All patients are advised to avoid excessive insolation and regularly conduct self-examination.

In order to timely detect a recurrence of the disease, all patients are prescribed dispensary observation:

• In the first year, the examination is carried out every three months.
• In the second year – once every 6 months.
• From the third year – once every 3 years.

In addition to a physical examination with palpation of regional lymph nodes, it is necessary to undergo an annual chest x-ray, abdominal and lymph node ultrasound, and computed tomography according to the schedule prescribed by the doctor.

The prognosis of the course of the disease directly depends on the speed of detection of the pathological process and the start of treatment. According to statistics, about 10% of patients die from a primary tumor, the remaining 90% die due to the development of distant metastases. If with stage I melanoma, the five-year survival rate is about 85%, then with stage IV it is only 5%. According to some authors, the life expectancy of patients with metastatic melanoma does not exceed 11 months. A poor prognostic sign is the appearance of secondary foci in the skin, which is characteristic of the late stage of melanoma and is usually combined with the presence of other metastases.

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New approaches to the treatment of metastatic melanoma can increase the survival of patients » Medvestnik

Melanoma in Russia ranks second in absolute increase in incidence among malignant tumors after lung cancer. Every year the number of cases is growing by 5%, and over the past 10 years, the increase was 28%. ¹ In total, about 95,000 people in Russia are currently registered with a diagnosis of skin melanoma with code C-43. ²

At an early stage, this disease is often treatable. Curability in skin melanoma in situ is achieved in 100% of cases, and in T1a melanoma – 5-year survival reaches 95%.

Advanced metastatic melanoma is a dangerous disease, but significant progress has been made recently in its treatment, including the use of combined targeted therapy and immunotherapy.

Combination targeted melanoma therapy is a personalized treatment. It is prescribed only to those patients who have a mutation in the BRAF gene in melanoma. When the gene is mutated, melanoma cells divide faster, survive better, and form their own blood vessels faster. Patients who have this mutation in their genes may be given combination targeted therapy at various stages of the disease.

Konstantin Titov, Head of the Department of Surgery and Oncology of the FNMO RUDN University :

“The first variant of prescription is for patients who have damage to regional lymph nodes. Here, adjuvant targeted therapy is prescribed for prophylactic purposes. The tablet form of drugs allows you not to interrupt the treatment and take them both at home and at work, while traveling, and so on. Preventive (adjuvant) immune or combined targeted therapy after radical surgical treatment (removal of metastatic regional lymph nodes) lasts 12 months.

The second option is when the patient has a so-called metastatic disease. Tumor progression with distant metastases. Then he goes into the group of inoperable disseminated tumor. When surgical treatment is practically no longer used (sometimes solidarity or residual single metastases are surgically removed after drug therapy). Accordingly, here, regardless of the BRAF mutation, there are two options – immunotherapy and combined targeted therapy. Combined targeted therapy is most often used in patients who have multiple metastases with a high growth rate, from which the patient can quickly die. Then we do not have much time for the immunotherapy to work (usually this can happen only at 12-14 weeks). Combined targeted therapy acts directly on the tumor and cells.

This is an “ambulance” for such patients: after 7-10 days from the start of taking targeted drugs, the patient may already notice an improvement in well-being, weakness, pain will decrease, appetite will appear, and maybe even some visible metastases may decrease. With this treatment, the disease can be controlled in 90% of patients. The five-year survival rate of patients who are taken under the control of combined targeted therapy is 34%. The rest develop resistance sooner or later. This is where immunotherapy comes into play.

At the same time, it should be noted that the effectiveness of combined targeted therapy is much higher than previously used methods of treatment, in particular chemotherapy. If with chemotherapy, the five-year survival rate of patients was only 5% of cases, then with combined targeted therapy it was 34%. Thus, the five-year survival rate of patients increased by 6 times due to the introduction of combined targeted therapy.

In the COMBI D/V clinical trial, targeted combination therapy has also shown benefits in terms of treating patients with BRAF-mutated metastatic skin melanoma. The appointment of combined targeted therapy to this group of patients, subject to a relatively favorable prognosis of the disease in the presence of a low tumor burden, normal LDH levels, and less than 3 areas affected by metastases, showed objective improvements in key indicators of the treatment of metastatic skin melanoma.