• Stage 4 melanoma is the most advanced stage, when skin cancer has spread to other organs of the body.
• Immunotherapy and targeted therapy are often recommended as treatment for stage 4 melanoma.
• In recent years, the survival rate with stage 4 melanoma has doubled due to advances in treatment research.

Stage 4 melanoma skin cancer — also known as metastatic melanoma — refers to cancer that has spread from the primary (main) tumor to other organs and parts of the body. At this stage, your symptoms, treatment options, and outlook are quite different from early-stage melanoma. (Cancer stages are sometimes noted with Roman numerals, as stages I through IV.)

In this article, we’ll discuss important facts to know about stage 4 melanoma. If you have more questions about your specific case of metastatic melanoma, talk to your doctor or oncologist (cancer specialist).

What Is Stage 4 Melanoma?

Doctors diagnose stage 4 melanoma when the cancer has spread from the primary tumor and metastasized.

During cancer staging, your doctor will look at details about where melanoma has spread in the body. Your doctor will also measure how much of a chemical called lactate dehydrogenase (LDH) is in your blood. LDH levels can provide clues to how much cancer is in your body and how aggressive it is.

Where Does Stage 4 Melanoma Spread?

Common parts of the body melanoma metastasizes to include:

• Other areas of skin
• Distant lymph nodes (small bean-shaped organs that support the immune system, found in many parts of the body)
• Soft tissues elsewhere in the body
• Lungs
• Liver
• Intestines
• Central nervous system, including the brain and spinal cord

How Common Is Stage 4 Melanoma?

According to data from the National Cancer Institute (NCI), stage 4 melanoma accounts for 4.7 percent of all cases. People may be diagnosed with metastatic disease as their first diagnosis, or their cancer may have returned and progressed after treatment for an earlier stage of melanoma.

Symptoms of Stage 4 Melanoma

Melanoma typically causes abnormal lesions (moles or spots) that are noticeable on the skin. It may look different from other moles or change size, shape, or color. Your specific symptoms will depend on the type of melanoma you have.

What Does Stage 4 Melanoma Look Like?

Stage 4 melanoma can look different ways. At stage 4, the tumor can become thicker and grow more deeply into the skin. There may be ulcerations (open sores) or even smaller tumors around it called satellite lesions.

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Nonskin Symptoms

In addition to skin symptoms, many people with metastatic melanoma also experience fatigue, weight loss due to loss of appetite, and headaches (in cases where the brain has been affected). Cancer uses your body’s energy and resources to continue growing, leading to uncomfortable symptoms. If melanoma has spread to nearby or distant lymph nodes, they may become swollen and hard.

Specific Symptoms of Stage 4 Melanoma Spreading

You may also notice different symptoms depending on where advanced-stage melanoma has spread. For example, people with metastasis to the lungs may experience symptoms like:

• Chest pain
• Coughing (with or without blood)
• Shortness of breath due to fluid buildup

If melanoma has moved into the bones, it can lead to symptoms including:

• Bone pain
• Bone breaks or fractures
• High blood-calcium levels that cause abdominal pain, dehydration, and confusion

Melanoma that has spread to the liver may cause:

• Pain and swelling on the right side of the abdomen
• Yellowing of the eyes and skin known as jaundice
• Itchy skin

If melanoma has spread to the brain, it can lead to:

• Headaches
• Memory problems
• Seizures
• Loss of ability to move your arms and legs

Treatments for Stage 4 Melanoma

Stage 4 melanoma is considered difficult to cure. In recent years, researchers have developed several new treatments for advanced melanoma. In certain cases where there aren’t many metastases, surgery may be used to remove tumors and lymph nodes causing symptoms. However, your doctor will likely prescribe systemic (whole-body) treatments to target cancer cells that have spread throughout your body.

Immunotherapy

Immunotherapy uses lab-engineered protein drugs to activate your immune system against melanoma. Examples include:

• Atezolizumab (Tecentriq)
• Interleukin (IL)-2 (Proleukin)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Nivolumab and relatimab (Opdualag)
• Pembrolizumab (Keytruda)
• Talimogene laherparepvec (T-VEC, sold as Imlygic)

Targeted Therapy

Targeted therapies block specific proteins made by cancer cells that can fuel growth or help them dodge the immune system. Around 50 percent of melanomas have changes or mutations in the BRAF gene. Doctors can prescribe BRAF inhibitors to target these proteins and stop cancer cell growth. BRAF inhibitors are usually combined with other medications known as MEK inhibitors for better efficacy.

BRAF and MEK inhibitor combinations for metastatic melanoma include:

• Dabrafenib (Tafinlar) and trametinib (Mekinist)
• Encorafenib (Braftovi) and binimetinib (Mektovi)
• Vemurafenib (Zelboraf) and cobimetinib (Cotellic)

Chemotherapy and radiation therapy may be used to treat melanomas that don’t improve with other treatments or can’t be removed with surgery.

Survival Rate With Stage 4 Melanoma

Receiving a stage 4 melanoma diagnosis can be scary and overwhelming. It can help to gain an understanding about the statistics surrounding survival rate and prognosis (outlook) with this disease.

Survival rates are based on large studies conducted over several years. These rates can’t predict how long you’ll live with stage 4 melanoma, but they can give you an idea of how likely it is that your treatment will be successful.

Researchers use the five-year relative survival rate to talk about the outlook with melanoma. This number compares people with stage 4 melanoma to people in the general population. Overall, it lets you know the chances of being alive after five years compared to someone without melanoma.

The National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program collects survival data for people living with melanoma. People with melanoma that has spread to distant parts of the body (stage 4) have a five-year relative survival rate of 35 percent. This means that people with stage 4 melanoma are 35 percent as likely to be alive after five years compared to the general population.

Studies also show that people with brain metastases or tumors that have spread to more than three areas of the body have a poorer prognosis.

It’s worth noting that new developments in melanoma treatment are now helping people live longer. In the past 20 years, five-year survival rates for melanoma have doubled. As clinical trials lead to more effective treatment plans, survival rates will hopefully continue to improve.

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.

Are you or a loved one living with stage 4 melanoma? Share your experience in the comments below, or start a conversation by posting on your Activities page.