Treatment for Stage 4 melanoma
This page is about treatment for stage 4 (advanced) melanoma skin cancer. There is information about
Stage 4 melanoma means the cancer has spread from where it started to another part of the body. It is also called advanced melanoma.
Where melanoma can spread to
Melanoma can spread anywhere in the body. The most common places for melanoma to spread are the lungs, liver, bones, brain, tummy or lymph nodes.
Deciding on treatment
Your treatment will depend on where the cancer has spread to, your symptoms, and what treatment you have already had. The doctor will also look at changes in the genes within the melanoma tumour.
There are several different types of treatment that doctors use for melanoma that has spread. You may have
• Biological therapy
Some newer treatments are being tested in clinical trials.
View and print the quick guide for treating advanced melanoma.
Stage 4 melanoma means the cancer has spread from where it started to another part of the body. It is also called advanced melanoma. Your melanoma may have already spread when it is diagnosed. Or it may come back in another part of the body some time after you were first diagnosed and treated.
Cancer that has spread to another part of the body is called secondary cancer or metastases.
Read more about stages of melanoma.
Melanoma can spread to almost anywhere in the body but the most common places for it to spread are the
Click on the links to find out more about secondary cancers and lymph nodes.
These are also shown in the diagram below.
Remember that 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.
Check with your doctor or specialist nurse 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.
Read more about secondary cancer in the lungs, liver, bones and brain.
For advanced melanoma the treatment that is right for you will depend on
- Where your cancer has spread to
- The symptoms you have
- The treatment you have already had
- Changes in the genes within the melanoma tumour
- Your general health
It can be difficult to decide which treatment to try, and in what order, and whether to have treatment at all. And this decision may be different for each person with advanced melanoma. Most people who choose to have treatment for advanced melanoma, will usually try more than one treatment.
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.
Discussing your options
Your doctor will discuss the options for treatment with you. There may also be a counsellor or specialist nurse at the hospital you could talk to. You may also want 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.
You can look at our melanoma organisations page for organisations that can give you information and tell you about how to get counselling and emotional support.
Your doctors may do genetic testing on your melanoma. They look to see if the melanoma cells have changes (mutations) in certain genes, such as the BRAF V600 gene. This helps them make decisions about which treatments may help you.
The two main types of biological therapy for melanoma are
• Targeted treatment
If you have a change in the BRAF 600 gene your doctor may offer you a targeted treatment. Some drugs work on melanoma with this gene change. About 40 to 50 out of every 100 people with skin melanoma (40-50%) have this gene change.
Targeted treatments that work on melanoma with the BRAF gene change include vemurafenib (Zelboraf) and dabrafenib (Tafinlar). They can shrink and control the melanoma for some time.
Immunotherapy is a type of biological therapy that helps the body's natural defence system (immune system) to find and destroy melanoma cells.
An immunotherapy drug called ipilimumab (Yervoy) can shrink advanced melanoma and control it for a time.
Pembrolizumab (Keytruda) is another type of immunotherapy that may help the immune system to kill melanoma cells.
Read more about biological therapy for melanoma. And read more about biological therapies in general.
Chemotherapy doesn't work as well against melanoma as it does in some other types of cancer. So doctors usually use biological therapies first. But if biological therapy is not suitable for you, or it has stopped working, you may have chemotherapy. Your doctor may offer you a chemotherapy drug called dacarbazine (DTIC).
Chemotherapy can help to shrink advanced melanoma and reduce symptoms in some people. Doctors have to balance the benefit of the chemotherapy against the likely side effects.
Read more about chemotherapy for melanoma. And read more about chemotherapy in general.
Surgery may sometimes be used to remove tumours that have spread to other areas of the body. This is called metastectomy.
If all the metastases can be removed it is called a complete metastectomy. After this type of surgery people can often stay well for months or perhaps years.
Read about surgery for melanoma.
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