What is advanced melanoma?

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.

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Symptoms of advanced melanoma

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.

Causes of advanced melanoma

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.

Diagnosis of advanced 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:

  • Blood tests

    You will have a blood test to check your general health and how well your kidneys and liver are working.

  • CT scan

    A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body.

  • Chest x-ray

    You will have a chest x-ray to check your lungs and heart.

  • MRI scan

    An MRI scan uses magnetism to build up detailed pictures of your body.

  • Ultrasound scan 

    Ultrasound scans use sound waves to build up a picture of part of the inside of the body.

  • Bone scan

    A bone scan shows up abnormal areas of bone. You have a small amount of a radioactive substance injected into a vein.

  • PET scan

    A PET scan uses low-dose radioactive sugar to measure the activity of cells in the body.

Stages of advanced melanoma

The results of your tests helps your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

Treatment for advanced melanoma

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: 

  • Immunotherapy

    Immunotherapy drugs use the immune system to find and attack cancer cells. They help control or shrink the growth of advanced melanoma.

  • Targeted therapy

    Targeted therapy drugs work by targeting something in or around the cancer cell that is helping it grow and survive. They help control or shrink the growth of advanced melanoma.

  • Radiotherapy

    Radiotherapy uses high-energy rays to destroy the cancer cells. It helps control symptoms if melanoma has spread to the brain, bones or skin.

Other treatments that are sometimes used are: 

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is not often used to treat melanoma.

  • Surgery

    Surgery is sometimes used to remove a secondary tumour if it is small and only in one place – this can help control symptoms, or rarely it may cure the melanoma.

Metastases (secondary cancers) in the skin may sometimes be treated with: 

  • Laser therapy

    A treatment called carbon dioxide (CO2) laser therapy can be used to help shrink advanced melanoma and to relieve symptoms.

  • Electrochemotherapy

    Electrochemotherapy is used to treat cancers on the skin. It can help control symptoms when other treatments are no longer working.

  • Chemotherapy into an arm or leg

    Chemotherapy can be given directly into a limb. This is called regional chemotherapy. It can treat clusters of melanomas that have come back on the same limb.

You may have some treatments as part of a clinical trial.

Living with advanced melanoma

Managing symptoms

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:

We have more information about controlling symptoms and side effects of advanced cancer.

Follow-up care

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:

Your feelings

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.

Reviewed: 01 July 2019
Reviewed: 01/07/2019
Next review: 31 January 2022
Next review: 31/01/2022

This content is currently being reviewed. New information will be coming soon.