What is advanced melanoma skin cancer?

Advanced melanoma skin cancer means it has spread to another part of the body such as the liver, lungs or bone. Where the melanoma has spread to is called a secondary cancer or metastasis.

The melanoma may have already spread when it was first diagnosed. Or it may have come back in another part of the body after your first diagnosis and treatment. Doctors call this recurrent cancer.

Where can melanoma skin cancer spread to?

Melanoma skin cancer can spread almost anywhere in the body. Depending on how far it has spread, doctors may call it:

• regional melanoma
• advanced melanoma

Regional melanoma skin cancer

Regional melanoma skin cancer means it has spread to either:

• an area between the melanoma and the nearby lymph nodes
• the lymph nodes close to where the melanoma started

Cancer cells found between the melanoma and the nearby lymph nodes are called either: 

• micro satellite metastases – these are tiny amounts of cancer cells found next to the melanoma. They can only be seen through a microscope
• satellite metastases – these are cancer cells found within 2cm of the melanoma
• in-transit metastases – these are cancer cells that have spread more than 2cm away from the melanoma but not as far as the nearest lymph node 

Regional melanoma is also called locoregional melanoma skin cancer. This is the same as stage 3 melanoma. It can usually be treated with surgery, targeted cancer drugs and immunotherapy.

If your surgeon can’t remove the melanoma, then you may have the same treatment as someone with advanced melanoma.

Advanced melanoma skin cancer

Advanced melanoma is also called metastatic or stage 4 melanoma.

Melanoma can spread to other areas on the skin or to soft tissue. Soft tissue includes muscles, nerves, fat, and blood vessels. Sometimes it can spread to more than one area.

Other common places for melanoma to spread include your:

• lymph nodes further away from the melanoma – which ones depend on where the melanoma is
• lungs
• liver
• bones
• brain
• small bowel

The aim of treatment for advanced melanoma is to control the cancer and help any symptoms. It may control the melanoma for a long time. And in a small number of people this can be for a number of years.

Symptoms of advanced melanoma skin cancer

Some people may not have any symptoms at all. They may only know the melanoma has spread when it is found on a follow up scan.

Other people may get symptoms. These depend on where the cancer has spread to. If it has spread to the lungs you may have shortness of breath. A secondary cancer in the liver may cause discomfort or pain on the right side of your tummy (abdomen).

If the cancer has spread to the stomach or bowel you may have pain or notice blood in your poo. Sometimes this can make your poo look black.

Decisions about your treatment

To help you decide on the best treatment you need to talk very carefully to your specialist. This will help you understand:

• what your diagnosis means
• what’s likely to happen
• what treatments are available
• how treatment can help you

It’s a good idea to find out:

• whether treatments have side effects that may affect your quality of life
• what the treatment involves, such as travelling back and forth to the hospital
• if there is a clinical trial you can take part in
• what happens if you decide not to have treatment

You may want to talk things over with a close friend or family member. Or there may be a counsellor you can discuss your feelings with.

Treatment for advanced melanoma skin cancer

Sometimes the melanoma may have already spread when you are first diagnosed. Your surgeon may recommend removing the original (primary) melanoma. But it depends on how many areas of the body it has spread to.

If the melanoma has only spread to one other part of the body, your doctor may also recommend you have surgery to remove the secondary cancer. Your doctor may refer you to a specialist surgeon for this operation.

Other treatments you might have for advanced melanoma skin cancer include:

• immunotherapy
• targeted cancer drugs
• radiotherapy to specific sites of melanoma, for example the bone or brain
• injecting treatment directly into the melanoma (intralesional therapy), for example talimogene laherparepvec (T-VEC)
• chemotherapy – usually you only have chemotherapy if you can’t have targeted or immunotherapy drugs
• chemotherapy directly into the arm or leg where the melanoma is (isolated limb infusion or isolated limb perfusion)
• chemotherapy combined with an electric current (electrochemotherapy)
• imiquimod cream
• taking part in a clinical trial

How you might feel

Finding out you have advanced melanoma can be a shock. It’s common to feel uncertain and anxious and not be able to think about anything else. There is lots of information and support available to you and your family and friends.

It can help to find out more about your cancer and the different treatments you can have. Many people find that knowing more about their situation can make it easier to cope. But some days you might want lots of information and on others it might be too much for you.