Table of ContentsView AllTable of ContentsSymptomsAppearanceDiagnosisTreatmentSurvival RatesCopingLifestyle Changes
Table of ContentsView All
View All
Table of Contents
Symptoms
Appearance
Diagnosis
Treatment
Survival Rates
Coping
Lifestyle Changes
Stage 4melanoma, otherwise known as metastatic melanoma, is the most advanced form of melanoma, a serious form ofskin cancerthat begins in cells known asmelanocytes. Melanocytes produce the pigment melanin, which gives your skin its color. In melanoma, they grow uncontrollably.
In stage 4, the melanoma has spread to other parts of the body or distant points in the skin. The lungs are one of the most common locations for the cancer to spread.Although melanoma is the rarest type of skin cancer, accounting for only 1% of all skin cancers, it is the deadliest and the main culprit behind most skin cancer deaths.
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Melanoma Symptoms
Symptoms vary from person to person, but the most common sign of melanoma is a new or changed mole. Any skin area that appears off in color, shape, size, or texture could also indicate melanoma. Typically, theABCDE ruleis used to identify changes in symmetry, shape, color, and size of the skin lesion.
There may be other symptoms, too. For example, you may experience a change in sensation in a melanoma mole. It may itch or become painful.
What Does Stage 4 Melanoma Look Like?
Symptoms of Skin Cancer
Metastatic melanomamost often spreads to the lymph nodes, brain, bones, liver, or lungs, and the additional symptoms experienced at this stage depend on where the melanoma has spread:
A person with advanced melanoma may also experience some of thegeneral symptoms of cancer, including:
If you are concerned you may have symptoms of melanoma or new symptoms associated with a current melanoma diagnosis, contact your healthcare provider for advice.
Tumor Ulceration
Changes in the skin occur throughout all stages of melanoma. The primary tumor may or may not show ulceration at any stage.However, when ulceration is present, the prognosis may be poorer.
Tumor Matting
Tumor Thickness
The thicker the tumor, the greater the chance it will spread. Melanomas with a tumor thickness of less than 1 millimeter generally don’t spread.
The ABCDEs of Skin Cancer
How Is Stage 4 Melanoma Diagnosed?
Typically, healthcare providers perform a physical exam and several tests to determine whether someone has melanoma and how advanced their melanoma is. Sometimes, late-stage melanoma is diagnosed through CT or MRI scans, which can help show the spread of the disease.
Skin lesions rarely disappear after the cancer has spread to other body parts. Occasionally, melanoma itself can form inside organs. For example, while rare, melanoma can originate from the gastrointestinal (GI) tract.
So, if you aren’t performing regular skin checks or yourmelanoma has a rare presentation, it is possible to have melanoma for several years before diagnosis.
The BRAF Gene Mutation and MelanomaRoughly half of all documented melanoma cases present with mutations in the BRAF gene.The melanoma cells that have these changes create a BRAF protein, which aids their growth.If a person with the BRAF gene mutation has melanoma, knowing about the mutation is of great benefit for treatment because healthcare providers can use targeted therapy to inhibit the BRAF gene mutation from aiding the growth of cancer.
The BRAF Gene Mutation and Melanoma
Roughly half of all documented melanoma cases present with mutations in the BRAF gene.The melanoma cells that have these changes create a BRAF protein, which aids their growth.If a person with the BRAF gene mutation has melanoma, knowing about the mutation is of great benefit for treatment because healthcare providers can use targeted therapy to inhibit the BRAF gene mutation from aiding the growth of cancer.
Roughly half of all documented melanoma cases present with mutations in the BRAF gene.The melanoma cells that have these changes create a BRAF protein, which aids their growth.
If a person with the BRAF gene mutation has melanoma, knowing about the mutation is of great benefit for treatment because healthcare providers can use targeted therapy to inhibit the BRAF gene mutation from aiding the growth of cancer.
If a diagnosis of melanoma is already established, the healthcare provider will consider two factors to determine the extent of stage 4 melanoma: the location of the distant tumors and whether the level ofserum lactate dehydrogenase(LDH) is elevated.
LDH is an enzyme responsible for turning sugar into energy.Higher LDH levelsmay indicate a worse prognosis.
Biopsy
When melanoma has spread to other organs, it can sometimes be confused with a cancer starting in that organ. Your healthcare team can test biopsy samples to determine whether it is a melanoma or other kind of cancer. Types of biopsies include:
Lab Tests
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Staging
The diagnostic process includes thestaging of melanoma. The staging system used to classify melanoma is the TNM system, which stands for:
The 5 Stages of Melanoma
Melanoma can recur because screening tests may not catch every cancer cell within the body, and the leftover cells could grow into another tumor. Melanoma has a recurrence rate of around 13.4% in individuals with a previous case of the disease.This recurrence rate is 70.2% within two years of initial diagnosis for people in stages 1 through 3 and 29.8% for those in stage 4.
Melanoma can recur because screening tests may not catch every cancer cell within the body, and the leftover cells could grow into another tumor. Melanoma has a recurrence rate of around 13.4% in individuals with a previous case of the disease.
This recurrence rate is 70.2% within two years of initial diagnosis for people in stages 1 through 3 and 29.8% for those in stage 4.
How Is Stage 4 Melanoma Treated?
Although the treatment of stage 4 melanoma is more complex, there has been a vast improvement in treatment options for those with this stage of melanoma. There are several treatment options, some of which are used in conjunction with other treatments for the best results.
Surgery
Surgery to remove tumors that have spread throughout the body is used to treat stage 4 melanoma. Still, in most cases, it is part of an overall treatment plancombined with immunotherapyand targeted therapy. Tumors are found and removed from the body where possible.
Radiation
Radiation treatmentis used for those with advanced melanoma when surgery isn’t possible because a person is at high risk for complications. This treatment uses energy rays to destroy tumors throughout the body or cancer cells in the lymph nodes.
Immunotherapy
Immunotherapystimulates a person’s immune system to fight off cancer cells. There are two types: systemic and local immunotherapy.
Systemic immunotherapyfor advanced melanoma puts substances designed to set an immune response in motion into the bloodstream.
Local immunotherapyinvolves injecting substances directly into lesions. This immunotherapy targets and kills melanoma cells at the source.
Immunotherapy drugs called checkpoint inhibitors help shrink tumors. They can also be used in people with tumors that have BRAF mutations. However, these types of drugs come with therisk of serious side effects, so those undergoing treatment using checkpoint inhibitors will need to be monitored closely during the treatment.
If checkpoint inhibitors aren’t working for someone with stage 4 melanoma, your healthcare provider may try using a different type of immunotherapy drug,interleukin-2. Interleukin-2 may help those with the disease live longer.
Targeted Therapy
Targeted therapy uses medications that target specific molecules within cancer cells. By blocking the abnormal function of those particular molecules, this therapy aims to slow the spread and growth of melanoma. The medications used for melanoma are BRAF inhibitors and MEK inhibitors.
Specifically, triplet therapy or triplet targeted therapy, a form of therapy that combines target therapy with immunotherapy, is used in people with the BRAF gene mutation and advanced melanoma.It has been shown to increase the response rate and progression-free survival.
In some cases of advanced melanoma, there are changes in a different kind of gene known as the c-KIT gene.Targeted therapy is also used to help those with this gene change, although the medications often lose their efficacy over time.
Chemotherapy
In some instances,chemotherapymay be a course of treatment for those with stage 4 melanoma. Chemotherapy is typically used only after trying other forms of treatment. This is because, although chemotherapy works to shrink melanoma, it often ends up recurring within months of the treatment.
Stage 4 Melanoma: Symptoms and Pictures
Clinical Trials
Stage 4 melanoma is often hard to treat with currently available options. Some people with the disease may want to look into available clinical trials studying new targeted therapy drugs, immunotherapies, and chemotherapies. Some clinical trials may also offer a combination of new treatment therapies that could benefit people with late-stage disease.
For example, researchers are investigating the use of apeptide vaccineto improve the overall survival rates of stage 4 melanoma.
It is estimated that stage 4 melanoma makes up 4% of all melanoma cases. The relative five-year survival rate drops from 99% in stages 1 and 2 to 66.2% in stage 3 to only 27.3% in stage 4.
Stage 4 melanoma is difficult to treat and has a low survival rate because it has metastasized. However, some patients with stage 4 melanoma respond well to treatment. It’s important to remember thatsurvival rates are estimates. Several other factors, including your age, general health, and genetic characteristics of your cancer, influence your prognosis.
Ten or more years ago, most individuals diagnosed with metastatic melanoma did not live beyond six to eight months. Now, most individuals live beyond three years after diagnosis, and several individuals have experienced long-term remissions of their cancer.
When found earlier,melanoma is easier to treat. Therefore, early detection can significantly improve melanoma prognosis. While there are treatment options for the most advanced stage of melanoma, there are instances where the treatment focuses on palliative and comfort care measures instead of a cure.
Coping With Stage 4 Melanoma
Stage 4 melanoma is a difficult diagnosis to cope with emotionally and physically. Still, there are things you can do to stay positive and deal with challenges that arise during your treatment journey.
Emotional Support
Emotional support can go a long way when dealing with a cancer diagnosis. Joining a support group such as theMelanoma Patient Support Group with Cancer CareorSmart Patients Melanoma Support Groupcan help you handle the challenges and emotions that come with living with advanced melanoma. The Cancer Support Group also has an online tool to help you search for specific groups in your area for in-person support.
You could also find support in other places, such as throughtherapy. If you are religious, getting in touch with your spiritual community may also be a good way to obtain support for coping with a late-stage melanoma diagnosis.
It’s also essential to stay as healthy as possible in other ways while undergoing treatment for stage 4 melanoma.
Eating Healthy
Eating a healthy diet full of whole foods, fruits, and vegetables can give your body the nutrients it needs to stay healthy.
For many, eating during treatment can be difficult due to the side effects of medications.Supplements may be necessaryto boost nutrient levels and help your body fight cancer. You may benefit from working with a dietician to help meet your nutritional needs.
Exercise
Light exercise is also an excellent habit during treatment because it can help your recovery. Exercise increases endurance, enhances immune function, and keeps the body strong.
Getting at least 30 minutes ofmild movementdaily can improve your overall health. You’ll want to eliminate unhealthy habits you may have while managing and coping with stage 4 melanoma, such as smoking or excessive alcohol consumption.
Preventing Infection
Melanoma treatment may also reduce the body’s ability to fight off further infections, which could make recovery and treatment more difficult. To reduce your risk of infection, practice good hygiene practices such asregular hand-washing, keeping your hands away from your face and eyes, avoiding crowds when possible, and inquiring about flu or pneumonia vaccines.
Staying Out of the Sun
Limit exposure to UV light. Since treatment can make the skin more sensitive to sunlight, spend less time in the sun, or cover up when you go outside.
You can wear clothing that covers all exposed areas of skin, including a hat, and ensure that you’re wearing sunglasses that can block out 99% to 100% of UVA and UVB rays. Always wear a broad-spectrum sunscreen if your skin will be exposed, andavoid tanning bedsaltogether.
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Summary
Getting an advanced cancer diagnosis is challenging. While stage 4 melanoma is more difficult to treat, there are several treatment options available, and survival rates continue to increase.
Speak to your healthcare provider regularly about your options and ask about the possibility of participating in clinical trials. Advanced therapies are being developed continuously, and you may be a good fit for a new treatment.
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