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Stage 4

Stage 4 is part of the number staging system. Stage 4 is also called advanced melanoma.

It means the melanoma has spread elsewhere in the body, away from where it started (the primary site) and the nearby lymph nodes.

The most common places for melanoma to spread include the:

  • lungs
  • liver
  • bones
  • brain
  • bowel
  • adrenal glands
  • distant lymph nodes
  • other areas of the skin

TNM stages

Doctors also use another staging system for melanoma called the TNM staging system. It stands for Tumour, Node, Metastasis.

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

Treatment

The stage of your cancer helps your doctor to 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 specific sites of melanoma spread, for example the bone or brain
  • injecting a drug directly into the melanoma (intralesional therapy), for example talimogene laherparepvec (T-VEC)
  • laser treatment using a carbon dioxide laser
  • chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
  • chemotherapy combined with an electric current (electrochemotherapy)
  • chemotherapy – usually you would only have chemotherapy if you’re unable to have a targeted cancer drug or immunotherapy
  • take part in a clinical trial

Other number stages

Last reviewed: 
27 Jun 2019
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017

  • Melanoma assessment and management
    National Institute for Health and Care Excellence, July 2015

  • Cancer: Principles and practice of oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    R Drummer and others
    Annals of Oncology, 2015. Volume 26, Supplement 5, Pages v126 - v132

  • Melanoma
    D Schadendorf and others
    The Lancet, 2018. Volume 392, Pages 971 - 984

  • BMJ Best Practice Melanoma
    BMJ Publishing Group, June 2018

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