Choose a type
Melanoma is a cancer that usually starts in the skin. It may start as a new mole or in a mole you already have.
Advanced melanoma is when melanoma cells spread from where they started (the primary melanoma) to other parts of the body. It is also called metastatic melanoma.
Melanoma cells can travel through the blood or the lymphatic system.
When the cells reach another part of the body, they may begin to grow and form another tumour. This is called a secondary melanoma or a metastasis.
The secondary cancer is made up of melanoma cells. Doctors treat secondary melanoma as melanoma, no matter where it is in the body. For example, they treat a secondary melanoma tumour in the lung as melanoma, not as lung cancer.
Sometimes melanoma has already spread to another part of the body when it is first diagnosed. Less commonly, some people are diagnosed with advanced melanoma without ever finding the primary melanoma.
Advanced melanoma is usually stage 4 melanoma. If stage 3 melanomas cannot be removed with surgery, they may be described and treated as advanced melanoma.
We have more information about:
Booklets and resources
Advanced melanoma can cause different symptoms. These depend on where the melanoma has spread to. There may also be some general symptoms. If you are worried about advanced melanoma, talk to your doctor or nurse and get advice.
We have more information about the signs and symptoms of advanced melanoma.
The biggest risk factor for melanoma is exposure to ultraviolet light (UV light). This can be through sunlight or sunbeds. Like most cancers, getting older is also a risk factor. But melanoma is more common in younger people than some other cancers.
We have more information about the causes and risk factors of melanoma.
If you have already had treatment for melanoma, you may have check-ups at a clinic. Sometimes advanced melanoma is diagnosed through tests you have at the clinic. Or your doctor may arrange tests to find out what is causing your symptoms.
If you notice new symptoms between check-ups, contact your cancer doctor or nurse. They may arrange some tests for you. Do not wait until your next appointment.
Sometimes melanoma has already spread to another part of the body when it is first diagnosed. Or tests after the melanoma has been removed may show it has spread.
A small number of people not previously diagnosed with melanoma are diagnosed with advanced melanoma. In this situation, doctors look for the primary melanoma and arrange any tests you may need.
Occasionally, they cannot find the primary melanoma. This is called melanoma of unknown primary. Doctors are not certain why this happens. It may be because the person’s immune system helped shrink the primary melanoma. Or the primary melanoma may have been removed for another reason.
The tests you have depend on your situation. If you are newly diagnosed with melanoma, you may start with tests on the nearby lymph nodes. If the melanoma has spread to the lymph nodes, you may have further tests.
Tests will check whether melanoma has spread to other parts of the body. They may include:
Tests on the melanoma cells
Your doctor may arrange tests to look for certain gene changes (mutations) in the melanoma cells. The results of this type of testing tell your cancer doctor which targeted or immunotherapy drugs are likely to work for you if you should need them.
The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.
Advanced melanoma is stage 4 melanoma. If a stage 3 melanoma cannot be removed with surgery, it may be treated as advanced melanoma.
Stage 4 means the melanoma has spread to other areas of the body such as:
- distant areas of skin
- distant lymph nodes
- the lungs, liver, bones or brain.
A team of specialists will meet to discuss the best possible treatment for you. This team is called a multidisciplinary team (MDT).
Your cancer doctor and nurse will explain the different treatments and their side effects. They will also talk to you about things you may want to think about when making treatment decisions. You and your doctor can then decide on the best treatment for you.
The aim of treatment for advanced melanoma is to control the cancer and help you to live for longer. The main treatments are immunotherapy and targeted therapy drugs, and targeted treatments are the most effective treatments for advanced melanoma. Many people are now living for a longer time with advanced melanoma.
Depending on your situation, you may have one or more types of treatment. Sometimes you may have treatment for advanced melanoma as part of a clinical trial.
Your doctor can also give you treatments or drugs to control different symptoms you may have.
The main treatments for advanced melanoma are:
Immunotherapy and targeted therapy are the most effective treatments for advanced melanoma. They may cause serious side effects. But your doctor and nurse will explain these so that you know what to look out for. This means side effects can be treated earlier before they become serious.
Other treatments are sometimes used:
You may have surgery to remove a tumour that has spread to another part of the body. This is only usually helpful if a tumour is small or they are all in the one area. For example, if melanoma has spread to the brain or lung, you may have surgery to remove the tumour.
You may have surgery to remove affected areas of skin or lymph nodes far away from where the melanoma started.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You do not usually have chemotherapy to treat advanced melanoma. If immunotherapy or targeted therapy drugs are not suitable or are no longer controlling the melanoma you might have chemotherapy.
You may have the following treatments to treat affected areas of skin or lymph nodes that cannot be removed with surgery. Some of these are only available at certain hospitals. Not all of them are available in every area of the UK. Your doctor or nurse can give you more information.
Chemotherapy into a limb
You may have chemotherapy directly into a limb. You may have this to treat clusters of melanoma in the arm or leg where the melanoma started. Chemotherapy into a limb is also called isolated limb perfusion (ILP) or isolated limb infusion (ILI).
T-VEC is a type of immunotherapy. You have it as an injection into an area of melanoma on the skin or in the lymph nodes. You only have it if the melanoma has not spread to other areas such as the bones or the brain.
Imiquimod is a cream that uses your body’s immune system to get rid of the cancer cells. You sometimes have it to treat small areas of melanoma on the skin.
You may have some treatments as part of a clinical trial.
You can have treatments to control symptoms and side effects alongside treatments such as immunotherapy or targeted therapy. Always tell your doctor or nurse about side effects or symptoms as there are things they can do to help.
Controlling side effects and symptoms is an important part of your care. You may see a doctor or nurse who are experts in symptom control. They may be based in hospital or in the community as part of a palliative care team. We have more information about controlling symptoms and side effects of advanced melanoma.
If melanoma comes back in the skin or lymph nodes, it may cause nodules or skin lesions. Some people may have visible scarring or skin changes. All this can affect body image. Talk to your nurse if this is a concern for you. There are different things that can help to improve body image changes.
Cancer and its treatment can also cause physical and emotional changes that may affect your sex life. You can read more about coping with these and things that may help in our information on cancer and sex.
You will have regular follow-up appointments with your cancer specialist or specialist nurse. They will check whether you have any side effects and whether symptoms have improved.
If you are having immunotherapy or targeted therapy, you may have regular scans to check how well treatment is working. You may have scans, x-rays or blood tests.
Your doctor or nurse can talk to you about symptoms or side effects to look out for. You will be given contact details for your specialist nurse. You can contact them for advice and support.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan is also here to support you. If you would like to talk, you can:
The following organisations also offer information and support:
Melanoma Focus provides information, guidance and support for patients, carers and healthcare professionals. It has a free helpline answered by expert skin nurses. It also has a Melanoma TrialFinder for melanoma trials in the UK.
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.
Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.
Below is a sample of the sources used in our advanced melanoma information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Keilholz U, Ascierto PA, Dummer R, et al. ESMO consensus conference recommendations on the management of metastatic melanoma: under the auspices of the ESMO Guidelines Committee. Annals of Oncology. 2020. 31 (11): 1435-1448 [accessed May 2022].
Peach H, Board R, Cook M, et al. Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73, 1, 36-42 [accessed May 2022].
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Samra Turajlic, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.