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Stage 4 melanoma skin cancer — also known as metastatic melanoma — refers to cancer that has spread from the primary (main) tumor to distant parts of the body. At this cancer stage, your symptoms, treatment options, and outlook may be quite different from stage 3 melanoma.
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 oncology care team.
According to the American Cancer Society, doctors diagnose stage 4 melanoma when the cancer has spread from the primary tumor to distant parts of the body.
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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 an enzyme 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.
Common parts of the body where melanoma may spread include:
According to the most recently available data from the National Cancer Institute, distant-stage melanoma — which is similar to stage 4 — accounted for 4.5 percent of melanoma cases diagnosed between 2014 and 2023.
People may be diagnosed with metastatic disease as their first diagnosis, or their cancer may have returned and progressed after an initial diagnosis at an earlier stage of melanoma.
Melanoma typically causes abnormal lesions (moles or spots) that are noticeable on the skin. A melanoma may look different from other moles or may change in size, shape, or color. Other symptoms can vary depending on where melanoma has spread in the body.
Stage 4 melanoma can look different from person to person. There’s no single skin appearance that identifies stage 4 melanoma because staging depends on distant spread rather than how the primary tumor looks.
The primary melanoma can be any thickness and may or may not have ulceration (an open sore). Smaller tumors called satellite lesions may also appear nearby.
However, the original lesion may not change much. In stage 4 melanoma, details about the primary tumor, such as its thickness or ulceration, no longer determine the stage because the cancer has already spread to distant areas of the body.
If pigment spreads beyond the borders of a spot into the skin around it, it may be a sign of melanoma. (CC BY-NC-ND 4.0/DermNet)
In addition to skin symptoms, many people with metastatic melanoma also experience fatigue, loss of appetite, weight loss, and headaches (if the brain has been affected). Cancer can also use nutrients your body needs, which may contribute to fatigue. If melanoma has spread to nearby or distant lymph nodes, they may become swollen and hard.
You may also notice different symptoms depending on where advanced-stage melanoma has spread. For example, people with melanoma that has spread to the lungs may experience symptoms such as:
If melanoma has spread to the bones, it can lead to symptoms including:
Melanoma that has spread to the liver may cause:
If melanoma has spread to the brain, it can lead to:
Stage 4 melanoma is often difficult to cure. In recent years, researchers have developed several new treatments for metastatic melanoma. When melanoma has spread to only a few areas, surgery may sometimes be used to remove tumors or enlarged lymph nodes, especially if they are causing symptoms.
If the melanoma has spread more widely, your doctor may recommend systemic (whole-body) treatments to target cancer cells throughout your body.
The treatment of melanoma is evolving quickly, so if first-line treatments don’t work, your oncologist may have other options available. You may also consider exploring clinical trials for stage 4 melanoma, which may offer access to newer treatments that are still being studied.
Immunotherapy may use lab-engineered protein drugs called checkpoint inhibitors to help your immune system attack melanoma.
Immunotherapy for melanoma also includes cellular and oncolytic viral therapies. Examples of immunotherapy include:
Atezolizumab (Tecentriq) is sometimes used for melanoma, but it isn’t a general standalone immunotherapy option. For melanoma with BRAF V600 mutations, it is used as part of a specific combination therapy.
Targeted therapies block specific proteins that help cancer cells grow. About 50 percent of melanomas have changes in the BRAF gene.
Doctors may prescribe BRAF inhibitors to target these proteins and slow cancer cell growth. BRAF inhibitors are usually combined with other medications known as MEK inhibitors because the combination often works better.
BRAF and MEK inhibitor combinations are commonly used to treat melanomas that have BRAF V600 mutations. BRAF and MEK inhibitor combinations for metastatic melanoma include:
Chemotherapy and radiation therapy may be used to treat melanomas that don’t improve with other treatments or can’t be removed with surgery.
Receiving a stage 4 melanoma diagnosis can be scary and overwhelming. It can help to gain an understanding of the statistics surrounding survival rates 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 survival rate compares people with stage 4 melanoma to people in the general population. Overall, it shows how likely people with melanoma are to be alive after five years compared with similar people without melanoma.
The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program collects survival data for people living with melanoma. SEER does not group melanoma using the stage 1-to-4 system. Instead, its “distant” category is similar to stage 4.
For people whose melanoma was first diagnosed after it had spread to distant parts of the body, the five-year relative survival rate is 36 percent, according to data from people diagnosed between 2015 and 2021. This means that this group is 36 percent as likely to be alive five years after diagnosis as similar people in the general population. These statistics apply to the stage at first diagnosis, not to melanoma that later spreads or comes back after treatment.
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.
New developments in advanced melanoma treatment are helping people live longer. Survival rates for melanoma have improved over the last 10 years, largely because of major advances in treatment.
Newer data suggests that outcomes for people with stage 4 melanoma have improved as newer treatments have become available.
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Dermatologist removed deep mole melanoma on rosy should I be seeing an oncologist she has me returning to do full body scan after several m
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I’m a stage four survivor of 8 years, targeted immunotherapy saved my life!!!
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