Melanoma is a cancer that usually starts in the skin. It can start in a mole or in normal-looking skin.
In advanced melanoma, the melanoma cells have spread from where the cancer first started (the primary site) to other parts of the body. Melanoma cells can travel through the blood or 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 cancer or a metastasis. The secondary cancer is made up of melanoma cells and the treatments doctors use are for melanoma. So a secondary melanoma tumour in the lung is treated as melanoma, not as lung cancer.
Advanced melanoma is also called stage 4 melanoma, or metastatic melanoma.
We have more information about:
- Melanoma that has come back in the same area (recurrent melanoma)
- Eye cancer (ocular melanoma)
- Anorectal melanoma.
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The symptoms of advanced melanoma depend on where the melanoma has spread to.
Symptoms can begin years after the original melanoma was removed. For some people the melanoma may be advanced when it is first diagnosed.
A small number of people who have not had melanoma before may develop symptoms of secondary melanoma. They may have had no previous signs of melanoma and no abnormal-looking moles.
The general symptoms of advanced melanoma can include:
- weight loss
- loss of appetite
- feeling very tired (fatigued).
If you are worried about advanced melanoma, we have more information about the signs and symptoms.
The main risk factor for developing melanoma is exposure to UV radiation. This can be through natural sunlight or the artificial light used in sunbeds or sunlamps.
Increasing age is also one of the main risk factors for melanoma. More than a quarter of melanomas are diagnosed in people aged over 75. We have more information about the risk factors for melanoma.
If you have already had treatment for melanoma, you may still be going to clinics for check-ups. Sometimes advanced melanoma will be found at one of these appointments, before you have any symptoms.
If you notice new symptoms between appointments, contact your cancer specialist. They may arrange some tests for you. Do not wait until your next appointment.
Rarely, some people have melanoma that is advanced without having found the original melanoma on the skin (primary).
Sometimes, melanoma has already begun to spread when it is first diagnosed. When the melanoma is first removed, your doctor will check the nearest lymph nodes. They may recommend taking a sample from the nearest lymph node if:
- the lymph nodes are swollen
- the doctor thinks the melanoma may have spread to the lymph nodes.
This is called a sentinel lymph node biopsy.
The sample may show there are melanoma cells in the lymph nodes. Or you may have symptoms that suggest the melanoma has spread elsewhere. In this situation your doctor may arrange further tests. These will depend on your symptoms.
Further tests for advanced melanoma
You may have some of the following tests:
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
When melanoma has spread to other parts of the body, the aim of treatment is usually to control the cancer and help you live longer. It may also help improve your symptoms and quality of life. Controlling the cancer might mean shrinking the size of the cancer or stopping it growing for a time. Newer treatments mean many people are living a long time with advanced melanoma.
Depending on your situation, you may have one or more types of treatment.
The main treatments for advanced melanoma are:
Other treatments that are sometimes used are:
Metastases (secondary cancers) in the skin may sometimes be treated with:
Chemotherapy into an arm or leg
You may have some treatments as part of a clinical trial.
Your doctors and nurses at the hospital or your GP practice will regularly check how you are feeling. They will check whether you are having any symptoms or side effects. It is important to tell your medical team how you are. This is so they can arrange the right treatment and help. You can also contact your specialist nurse if you have any worries.
For some people, treatment may no longer be controlling the cancer. In this situation, your doctor may suggest trying to ease symptoms rather than trying to shrink the cancer. This will help you feel better and have the best possible quality of life.
Palliative care teams based in hospitals and the community are experts in helping control symptoms such as pain. Your GP or cancer specialist can refer you to a palliative care team.
Some common symptoms that people with advanced melanoma may experience include:
- tiredness (fatigue)
- eating changes
- feeling sick or being sick
- coping with a change in appearance
- effects on your sex life
We have more information about controlling symptoms and side effects of advanced cancer.
You will have regular follow-up appointments with your cancer specialist or specialist nurse. They will check whether you have any side effects, and that symptoms have improved. You may have scans, x-rays or blood tests. They will also show you how to check your skin for any changes. You will be given contact details for your specialist nurse. You can contact them any time 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:
It is natural to have a mix of emotions when coping with advanced cancer. These feelings can occur at different times, and they may be different from day to day. Most people find that over time their feelings may become easier to cope with.