Melanoma is a type of skin cancer that can spread to other parts of the body — a process called metastasis. Although melanoma is less common than other types of skin cancer, it’s often considered the most dangerous because it’s more likely to spread.

If you’ve been diagnosed with melanoma, it’s important to learn about the risk of metastasis. This article will help you understand how and where melanoma metastasizes, symptoms of metastatic melanoma, and how it’s treated if it develops.

What Is Metastatic Melanoma?

Metastatic melanoma happens when cancer cells from the primary tumor (where cancer first started) break away and spread to other parts of your body. Melanoma cancer cells can travel to distant sites using your blood or lymph (colorless watery fluid) and grow into a new tumor. When melanoma has spread to another organ, it’s known as metastatic melanoma. Metastatic melanoma is also called stage 4 melanoma.

Read more about how doctors stage melanoma.

1. Melanoma Is More Likely To Spread to Certain Areas

It’s possible to develop metastatic melanoma in any part of your body. However, melanoma is more likely to spread to certain organs. The most common sites of metastatic melanoma include:

• Another area of skin
• Distant lymph nodes
• Lungs
• Liver
• Brain
• Bones
• Digestive tract

Common areas melanoma spreads to include other areas of skin, lymph nodes, lungs, and liver.

2. Most People Are Diagnosed Before Melanoma Spreads

Most people are diagnosed with melanoma in the early stages before it spreads to other parts of the body. If melanoma is found early, it’s often very treatable. Detecting melanoma early can help prevent metastatic melanoma. However, it’s estimated that nearly 40 percent of people who die of metastatic melanoma are diagnosed with an early stage of melanoma that later spreads.

It’s also possible to be diagnosed with metastatic melanoma before you or your health care provider find a primary melanoma tumor. For example, acral lentiginous melanoma, a type that affects the hands and feet, may be difficult to detect because it tends to develop in people of color, who usually aren’t considered at high risk of melanoma. That could lead to this type of melanoma being diagnosed at an advanced stage and noticed only after it has spread.

3. Risk of Spreading Depends on the Type of Melanoma

Lentigo maligna melanoma is considered less likely to spread than other kinds of melanoma. This type grows very slowly and usually stays in the same layer of skin for many years before it starts to invade nearby tissues. Lentigo maligna melanoma often develops in sun-exposed areas of light-skinned women, such as the face, according to the University of Texas MD Anderson Cancer Center. This visibility can make it easier to diagnose at an early stage.

Nodular melanoma is considered the most aggressive type of melanoma and is a risk factor for metastatic melanoma. Melanoma that grows quickly or isn’t recognized early on may also lead to metastatic melanoma.

According to City of Hope, other risk factors associated with an increased risk of developing metastatic melanoma include:

• Male sex
• A primary tumor that’s thicker than about an eighth of an inch (4 millimeters)
• Primary tumor ulceration (open sores)

4. Symptoms Depend on Where Melanoma Spreads

Metastatic melanoma can cause a wide variety of symptoms depending on which part of your body is affected. We’ll cover some common symptoms of a few of the areas where melanoma can spread.

Symptoms of metastatic melanoma depend on where the cancer has spread. For instance, lung metastasis may cause coughing, whereas brain metastasis may cause headaches.

Skin

If melanoma spreads to another area of your skin, you may see a fast-growing black or red spot, which may bleed or break open. Melanoma can also spread to areas under the skin’s surface. These tumors often appear as firm lumps.

Lymph Nodes

If melanoma spreads to your lymph nodes, it can cause these small, bean-shaped organs to be swollen or painful. You may also have swelling in your arms or legs if melanoma cells block the flow of lymph in one of your lymph nodes. This is called lymphedema.

Lung

Metastatic melanoma that affects the lungs may cause symptoms such as:

• A cough that doesn’t go away
• Coughing up blood
• Chest pain
• Trouble breathing

Liver

If melanoma spreads to your liver, your symptoms may include:

• Decreased appetite
• Fatigue (extreme tiredness)
• Yellowing of your skin or the whites of your eyes (jaundice)
• Itching
• Swelling
• Abdominal pain

Brain

Symptoms of metastatic brain cancer may include:

• Headache
• Changes in vision or hearing
• Difficulty swallowing
• Seizures
• Inability to move part of your body
• Nausea and vomiting
• Fatigue
• Behavior changes

Bones

Melanoma that spreads to your bones may cause symptoms such as:

• Bone pain
• Back pain
• Bones that easily break

Additionally, bone breakdown caused by cancer can raise your calcium levels. An increased calcium level can cause symptoms, including:

• Drowsiness
• Confusion
• Changes in your bowel habits

5. Tests Can Check if Melanoma Has Spread

Melanoma is most often initially diagnosed with a biopsy of the original tumor. During a biopsy, your health care provider will take a sample of tissue to examine under a microscope. Additional tests can help determine whether melanoma has spread to other parts of your body.

Lymph Node Biopsy

Melanoma usually first spreads to a lymph node near the primary melanoma tumor. When you’re diagnosed with melanoma, your health care provider may recommend a sentinel lymph node biopsy to learn if melanoma has spread to any of your lymph nodes.

Imaging Tests

Imaging tests produce an image of the inside of your body to help your doctor check for tumors. Examples of imaging tests that may be used to diagnose metastatic melanoma include:

• Computed tomography (CT) scan
• Positron emission tomography (PET) scan
• Magnetic resonance imaging (MRI) scan
• Ultrasound

Blood Tests

Certain blood tests check for substances in your blood that can indicate if cancer has spread. For example, your health care provider may check your levels of lactate dehydrogenase (LDH). High LDH levels are linked with poorer outcomes. Your provider may order other blood tests to check your overall health.

6. Metastatic Melanoma Can Be Difficult To Treat

Metastatic melanoma cancer treatment depends on which organs are affected. Treatment options include a combination of surgery, radiation therapy, and medications. Unlike treatment for other types of cancer, chemotherapy isn’t often used for metastatic melanoma because targeted therapies and immunotherapies usually work better.

Chemotherapy isn’t often used to treat metastatic melanoma because targeted therapies and immunotherapies usually work better.

Surgery

Surgery can be used to remove the primary tumor, affected lymph nodes, and tumors in other organs. Removing the tumor may control some cancer symptoms and help you live longer.

Radiation Therapy

Radiation therapy uses high doses of radiation to kill cancer cells. This treatment isn’t commonly used to treat melanoma skin cancer, but it may be used after surgery to help prevent cancer from coming back.

Targeted Therapies

Targeted therapies are medications that kill cancer cells that have specific genetic mutations, or changes to the DNA. Examples of targeted therapies for metastatic melanoma include:

• Dabrafenib (Tafinlar)
• Encorafenib (Braftovi)
• Trametinib (Mekinist)
• Vemurafenib (Zelboraf)

Immunotherapy

Immunotherapy uses your own immune system to attack and kill melanoma cancer cells. Examples of immunotherapy drugs for metastatic melanoma include:

• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)
• Lifileucel (Amtagvi)
• Nivolumab (Opdivo)
• Nivolumab/relatlimab (Opdualag)
• Pembrolizumab (Keytruda)

7. More Distant Spread Means Worse Outcomes

According to the American Cancer Society, the chance of living at least five years after diagnosis (called the 5-year survival rate) is 35 percent for people with melanoma that’s spread to distant parts of the body. The number and types of organs affected can also affect your outlook.

If melanoma has spread regionally to nearby lymph nodes or surrounding tissues, the 5-year survival rate is 74 percent. When melanoma is diagnosed at an early stage, the 5-year survival rate is higher than 99 percent. Regular skin exams done by yourself or a dermatologist (a specialist in skin conditions) can help find melanoma before it spreads and improve your outcome.

Read more about how doctors evaluate your prognosis with melanoma.

Melanoma research is constantly evolving. Talk to your health care provider about new treatments that may be able to improve your outlook with metastatic melanoma. You can also ask your oncology care team if you may be eligible to join any clinical trials for metastatic melanoma and get access to additional options.

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with melanoma.

Have you been diagnosed with metastatic melanoma? Share your experience in the comments below, or start a conversation by posting on your Activities page.