Advanced melanoma (Stage 4)

Advanced melanoma means the cancer has spread from where it started to another part of the body. It is also called stage 4 melanoma. Your melanoma may have already spread when it is diagnosed. Or it may come back in another part of the body sometime after you were first diagnosed and treated. This is called 'recurrent' melanoma. Cancer that has spread to another part of the body is called secondary cancer or metastases.  You may want to contact a helpline for more information.  Or for help with the emotional difficulties in coming to terms with having an advanced cancer. You can find organisations that can help you on the melanoma organisations page

Melanoma can spread to almost anywhere in the body but the most common places for it to spread are the

• Lungs
• Liver
• Bones
• Brain
• Abdomen
• Lymph nodes

These are shown in the diagram below.

Remember - melanoma may cause symptoms depending on where in the body it has spread to. But you are also likely to have aches and pains and off days in the same way as anyone else. So if you get aches or pains, they may not always be due to the melanoma. But do check with your doctor about any symptom that is worrying you. It may not be caused by your cancer but if it is, the sooner you get treatment the better.

Chemotherapy, radiotherapy and biological therapies may all be used to treat advanced melanoma. There is information about all these treatments in this section of CancerHelp UK. Surgery may sometimes be used to remove tumours that have spread to other areas of the body. This is called metastasectomy. If all the metastases can be removed it is called a complete metastasectomy, people can often remain well for months or perhaps years afterwards.

In one study, 4 out of 10 people (40%) who had all their secondary melanoma removed were still alive 5 years later. But this operation is not suitable for everyone with stage 4 melanoma, and more trials need to be done to see just how well it works. Other treatments may be given before or after surgery. Research tells us that some cancer treatments such as chemotherapy will work better for smaller tumours than larger ones.

Which treatment is right for you will depend on

• Where your cancer has spread
• The symptoms you have
• The treatment you have already had

Chemotherapy and radiotherapy may help to relieve symptoms. Some experimental techniques are combining chemotherapy with biological therapy. Interferon and vaccines are types of biological therapies also known as immunotherapy treatment. Information about these and other new treatments for melanoma is included on our what's new page, further on in this section.

Many clinical trials are going on with melanoma patients to try to find out whether one treatment is more effective than the others. If you would like to be part of a clinical trial into a new treatment, talk to your specialist or GP. They may be able to find a trial going on in, or near, your hospital. You can also find clincial trials in melanoma by using our clinical trials database. Pick 'melanoma' from the drop down menu of cancer types.

It can be difficult to decide which treatment to try. Or whether to have treatment at all when you have an advanced cancer. You will need to think about how the treatment will affect your day to day life. This includes whether it may cause side effects, as well as stresses such as travelling back and forth to the hospital. Most importantly, you will need to understand what the treatment you are offered can do to control the melanoma.

Your doctor will discuss the options for treatment with you. There may also be a counsellor or specialist nurse at the hospital you could chat to. You may also wish to talk things over with a close relative or friend.  It can be helpful to talk over difficult decisions with someone outside your circle of family and friends. Look at our melanoma organisations page for organisations that can give you information and tell you about how to get counselling and emotional support.