Advanced melanoma (Stage 4)
This page is about treatment for advanced melanoma skin cancer. There is information about
What advanced melanoma is
Advanced melanoma means the cancer has spread to another part of the body. 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 treated. This is called recurrent melanoma. Cancer that has spread to another part of the body is called secondary cancer or metastatic cancer.
Treatments for advanced melanoma
For melanoma that has spread, you may have chemotherapy, radiotherapy, biological therapy or surgery. Chemotherapy and radiotherapy may help to shrink melanoma and relieve symptoms. The biological therapies ipilimumab (Yervoy), vemurafenib (Zelboraf), interferon and interleukin 2 can help to shrink and control melanoma for a time. Vemurafenib only works for people who have a change in a gene called BRAF V600. Sometimes surgery can remove tumours that have spread to other parts of the body.
Which treatment should I have?
Which treatment is right for you will depend on where your cancer has spread, the symptoms it is causing, and the treatment you have already had. Your doctor or specialist nurse will discuss the options for treatment with you.
The treatment team
A team of health professionals working together will plan your treatment. They are specialists in the treatment of advanced stage melanoma. The team is called a Specialist Skin Cancer Multidisciplinary Team (SSMDT).
Experimental techniques using new drugs or combining chemotherapy with biological therapy are also being tried. If you would like to be part of a clinical trial into a new treatment, talk to your doctor.
View and print the quick guide for treating advanced melanoma.
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 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.
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. But do 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.
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
It can be difficult to decide which treatment to try, and in what order. And this decision may be different for each person with advanced melanoma. It can be difficult to decide whether to have treatment at all when you have an advanced cancer. The treatment will not cure the melanoma but cancer drugs or radiotherapy may shrink it or control it for a time. 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.
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.
A biological therapy called ipilimumab (Yervoy) can shrink advanced melanoma and control it for a time. You have it as a drip (intravenously).
A drug called vemurafenib (Zelboraf) can shrink melanoma in people who have a change in a gene called BRAF V600. About half the people with melanoma have this gene change. Vemurafenib is called a BRAF inhibitor and you take it as a tablet.
There is information about these treatments on the page about biological therapies for melanoma in this section.
Chemotherapy can help to shrink advanced melanoma and reduce symptoms in some people. Doctors have to balance the benefit of the chemotherapy against the possibility that the chemotherapy will cause side effects. The drug most commonly used is dacarbazine (DTIC). Sometimes it is used with other chemotherapy drugs, such as carmustine (BCNU), vinblastine or cisplatin. Temozolomide is also used. It is a similar chemotherapy drug to dacarbazine, but you take it as a tablet.
You can find information about chemotherapy for melanoma and the side effects in this section.
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.
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 only suitable for a small number of people with stage 4 melanoma. 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. So sometimes surgery can be used before other treatments.
If the secondary tumours are in the brain, they may be difficult or impossible to remove and the outlook is then not so good.
A team of health professionals work together to plan your care. They are specialists in the care of people with advanced stage melanoma. The team is called a Specialist Skin Cancer Multidisciplinary team (SSMDT). It includes specialist surgeons and cancer doctors, a specialist nurse, an occupational therapist, camouflage make up specialist, and a counsellor or psychologist.
Many clinical trials are going on with advanced melanoma patients to try to find out which treatments work best.
Some experimental techniques are combining chemotherapy with biological therapy. Information about these and other new treatments for melanoma is included on our melanoma research page, further on in this section.
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 clinical trials in melanoma by using our clinical trials database.
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