Stage 4 melanoma skin cancer
The number stage of a melanoma tells you how thick it is and if it has spread. It also tells you whether the top layer of the melanoma looks broken (ulcerated) when looked at under a microscope. Knowing this helps your doctor decide which treatment you need.
Unfortunately, Stage 4 melanoma skin cancer means the cancer is 
. Treatment aims to control the cancer and help relieve symptoms.
How does your doctor work out the stage?
To diagnose melanoma your doctor removes the abnormal area and a small area of surrounding skin. This is called an excision biopsy. A specialist doctor (pathologist) looks at the biopsy under a microscope. If there are melanoma cells, they will work out the stage of the cancer.
You normally have some other tests and scans to help with this.
What is stage 4 melanoma skin cancer?
Stage 4 means the melanoma has spread to parts of the body away from the original (primary) cancer and further than the nearby .
Melanoma can spread to other areas on the skin or to soft tissue. Soft tissue includes muscles, nerves, fat, and blood vessels. Sometimes it can spread to more than one area.
Other common places for melanoma to spread include your:
- lymph nodes further away from the melanoma – which ones depend on where the melanoma is
- lungs
- liver
- bones
- brain
- small bowel
Where the melanoma has spread to is called a secondary cancer or metastasis.
TNM stages
Doctors also use another staging system for melanoma called the TNM staging system. It stands for Tumour, Node, Metastasis.
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T describes the size of the tumour
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N describes whether there are any cancer cells in the lymph nodes
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M describes whether the cancer has spread to a different part of the body
The TNM staging system describes the cancer in detail. The number staging system puts these details together to give an overall stage. This can be easier to understand.
In the TNM staging system, stage 4 is:
- Any T, Any N, M1
Treatment for stage 4 melanoma skin cancer
The stage of the cancer helps your doctor decide what treatment you need. Treatment also depends on:
- where the melanoma is
- your general health and level of fitness
Treatment for stage 4 melanoma can help control the cancer and help to relieve symptoms. You might have one or more of the following treatments:
- surgery
targeted cancer drugs immunotherapy radiotherapy to the secondary melanoma, for example the bone or brain- injecting a drug directly into the melanoma (intralesional therapy), for example talimogene laherparepvec (T-VEC)
chemotherapy directly into the leg or arm where the melanoma is (isolated limb infusion or isolated limb perfusion)- chemotherapy combined with an electric current (electrochemotherapy)
- chemotherapy into your bloodstream (intravenously) – usually you would only have this if you’ are not able to have targeted cancer drugs or immunotherapy
Clinical trial
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
