Metastatic Melanoma: Symptoms, Causes, Risk Factors, Diagnosis, Treatment, Complications, Survival Rates


Metastatic melanoma occurs when the cancer spreads from the tumor to other parts of your body. This is also known as stage 4 melanoma.

June 1, 2018

Metastatic melanoma occurs when the cancer spreads from the tumor to other parts of your body. This is also known as stage 4 melanoma.
There are several types of metastatic melanoma. It may be spread through the lymphatic system to local lymph nodes which may show up as swollen lymph glands or as a string of skin tumors along a lymphatic chain. Melanoma may also spread through the bloodstream, where it may appear in one or more distant sites, such as the lungs, liver, brain, remote skin locations, or any other body location.
Although in most cases it can't be cured, treatments and support can help you live longer and better.

Symptoms of Metastatic Melanoma:

Signs and symptoms depend upon the location of metastasis and the amount of tumor there. Symptoms include:

  • headaches, unusual numbness in the arms and legs, or seizures if metastases to the brain
  • hardened lumps under your skin
  • swollen or painful lymph nodes
  • shortness of breath, other trouble breathing, chest pain, difficulty breathing or a cough that doesn't go away, if the cancer has spread to your lungs
  • enlarged liver or loss of appetite or any other signs of liver failure, if the cancer has spread to your liver or stomach. It may be first identified by abnormal blood tests of liver function long before the patient has jaundice.
  • pain and blood in the urine if spread to the kidneys
  • bone pain or broken bones called pathologic fractures, if the cancer has spread to the bone
  • fatigue, weight loss, weakness for very large tumor

In very rare case the patient may develop brown or black urine and have their skin turn a diffuse slate-gray color due to release of excess melanin into the circulation. The appearance of multiple blue-gray nodules or hard bumps in the skin of a melanoma patient may indicate widespread melanoma metastases to remote skin location.

Causes and Risk factors of Metastatic Melanoma:

Metastatic melanoma occurs when the melanoma is not detected and treated early stage. The risk of melanomas becoming metastatic is higher in those who have:

  • primary melanomas, which are visible skin growths
  • melanomas that aren't removed
  • a suppressed immune system

Diagnosis of Metastatic Melanoma:

Your doctor will ask you some question before doing any test. These may include:

  • How are you feeling and when and what did you noticed?
  • Have you been diagnosed with melanoma before and 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?

A skin examination will be done if you haven't already been diagnosed with melanoma. You will need a biopsy to find out the type of skin cancer. The biopsy can be one of the following 3 types:

  • Punch biopsy which removes a round piece of skin.
  • Excisional biopsy the the entire growth will be taken out.
  • Shave biopsy where your doctor tries to shave off the entire growth.

The growth of the tumor will be seen under a microscope by a doctor to see how thick it is. The more thicker the tumor the more serious is the cancer. You may also have a blood test and an imaging test if you have been diagnosed with melanoma to see if it has spread to other areas.
The different types of imaging tests include:

  • Chest X-ray which uses radiation in low doses to make pictures of the inside of your body.
  • CT scan or computerized tomography,uses powerful X-rays to produce a detailed image.
  • MRI or magnetic resonance imaging, which 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, which test uses radioactive material to look for signs of cancer.

The doctor will also check the sign for your enlarged lymph nodes. Lymph nodes are bean-sized glands under the skin in your neck, underarms, and groin. The doctor will do a fine-needle aspiration biopsy in which he uses a thin needle to remove a sample of cells.
The doctor may also do a lymph node biopsy in which the lymph nodes that are most likely to have cancer cells will be removed. This is also called as sentinel node biopsy which involves injecting dye into the area the melanoma was removed from. The dye moves to the nearby lymph nodes. These lymph nodes are then removed and screened for cancer cells. It will be considered that the cancer hasn't spread if these lymph nodes, called sentinel nodes, don't have cancer. The results of these tests help the doctor determine the stage of your cancer and how widespread it is.
The best treatment plan can be decided by discussing the pros and corns of all options with your doctor once you know that information.
If you notice an unusual mole or growth, make an appointment to get it checked by a dermatologist, the doctor who specializes in skin conditions.

Treatment of Metastatic Melanoma:

Treatment for a melanoma growth will begin with excision surgery to remove the tumor and cancer cells around it. Surgery alone can treat melanoma that hasn't spread yet.
Other treatments are required once the cancer has metastasized and spread. Mostly metastatic melanoma can't be cured. Therefore the goals of treatment are to shrink or stop the growth of the disease where it has spread and stop it from spreading to new areas. The purpose of treatment is to make you more comfortable relieving the symptoms.
Your treatment may include:

Surgery:

Your doctor may remove tumors or lymph glands. Probably surgery alone won't cure the cancer, but it can help you live longer and have fewer symptoms.
Radiation, immunotherapy, or chemotherapy may be suggested along with surgery to treat metastatic melanoma for advanced stage, such as when the melanoma has spread to other parts of the body.
Radiation and chemotherapy can help some people, depending on the size and location of the cancer.

Immunotherapy:

Certain drugs are given through an IV or a shot in high doses that can boost your immune system so it can better attack the cancer.
Although these can have serious side effects, but it can also shrink metastatic melanomas and help some people live longer. These drugs include:

Interferon-alpha and interleukin-2:

These drugs can help some people live longer.

Ipilimumab or Yervoy:

This drug can be used for two purpose. It can be given to individuals who have had surgery to remove melanoma in order to prevent the recurrence of melanoma. It can also be used for late-stage melanoma that cannot be removed by surgery.
But the drug doesn't work for everyone, and it can have serious, even life-threatening, side effects.

Nivolumab or Opdivo:

It works by inhibiting the PD-1 protein on cells, which blocks the body's immune system from attacking melanoma tumors. An increase in overall survival has been seen by using this drug.

Pembrolizumab or Keytruda:

Keytruda may shrink tumors in people with advanced melanoma who have already been treated with Yervoy. It is given as an IV infusion every 3 weeks.

Targeted therapy:

This kind of treatment aims to kill cancer cells without harming healthy ones. Because these treatments target the tumors, they may cause fewer side effects than chemotherapy or radiation.
They may work for people who have certain changes in genes. Some people who have melanoma have changes in the gene called BRAF, which helps cancer cells grow. If you have a tumor with BRAF, these drugs may shrink it and extend your life by attacking the gene. They include Dabrafenib and Vemurafenib.
Cobimetinib and Trametinib are some drugs that block an enzyme called MEK. This enzyme is often overactive in some cancers. These drugs, works in combination with a BRAF inhibitor to attack cancer cells and seems to shrink tumors for a longer period of time.
Many of these medications are now being used in combination to get better therapeutic effects than they would benefit using alone. All of these medications have significant side effects, including some that are life-threatening. Therefore these are recommended only for stage 3 tumors to prevent recurrence and spread and stage 4 metastatic tumors that are no longer vulnerable to surgery.

Complications caused by treatment:

  • The treatments for metastatic melanoma can cause nausea, pain, vomiting, and fatigue.
  • Removal of your lymph nodes can disrupt the lymphatic system which can lead to fluid buildup and swelling in your limbs, called lymphedema.
  • Confusion or mental cloudiness during chemotherapy treatment is often common in some people which is temporary.
  • Others may experience peripheral neuropathy or damage to the nerves from the chemotherapy which can be permanent.

What is recurrent melanoma?

Recurrence of tumor at the site of removal of a previous tumor, such as in, around, or under the surgical scar is refer as recurrent melanoma. It may also refer to the appearance of metastatic melanoma in other body sites such as skin, lymph nodes, brain, or liver after the initial tumor has already been treated.
Recurrence is most likely to occur within the first five years of initial treatment. However, new tumors may develop decades later. Sometimes it is difficult to distinguish recurrences from new primary tumors.

Survival rates for Metastatic melanoma:

Survival rates for metastatic melanoma vary widely according to many factors, including the age of patient, overall health, location of the tumor, particular findings on the examination of the biopsy, and more importantly the depth and stage of the tumor.
Survival statistics are generally based on five-year survival rates rather than the cure rates. The five-year survival rate is greater then 90 percent for stage 1. It is 80 to 90 percent for stage 2 and 50 percent for stage 3 where as 10 to 15 percent for stage 4.

Outlook for Metastatic melanoma:

Melanoma is curable if detected and treated early. But once melanoma has become metastatic, it is much harder to treat. It is very important to continue regular follow-ups with your doctor if you have had metastatic melanoma or melanomas in the past. There is possibility of recurrence of metastatic melanoma, and it can even come back in other parts of your body.
Early detection is essential to treating melanoma successfully before it becomes metastatic. Annual skin cancer check should be done by your dermatologist to detect it in early stage. You should also call them if you notice new or changing moles.