Metastatic Melanoma

Metastatic Melanoma

If you or a loved one have recently received a diagnosis of metastatic melanoma, you may have questions about what this means for you. What symptoms are associated with this advanced form of melanoma? What can you expect in the coming weeks and months? And what treatment options are available to you at this time?

In this article, we will explain what metastatic skin cancer is, what its causes are, and what symptoms patients with this disease often experience. Additionally, we will explain the diagnostic process for advanced melanoma, detailing what treatments are available to help skin cancer patients live longer and higher quality lives.

A cancer diagnosis of any kind is always frightening and upsetting for people and their loved ones, but being informed can help you to cope with this most unfortunate situation. To that end, we hope that this article is informative and helps give you a better idea of what a life with metastatic melanoma looks like.

What Is Melanoma?

Skin cancer can be broadly divided into two types: melanoma and non-melanoma skin cancer.

Melanoma skin cancer develops from melanocytes—a type of cell present in the skin and eyes responsible for producing the pigment melanin. It is this pigment that gives skin and irises their color and also provides protection from the sun. When UV radiation from the sun causes damage to these skin cells, it can lead to melanoma skin cancer.

Non-melanoma skin cancer is less serious than its counterpart. This type of cancer develops from skin cells known as basal cells and squamous cells. Occasionally, other rarer types of non-melanoma skin cancer may occur.

Compared to melanoma skin cancer, non-melanoma skin cancer has a much higher cure rate. Many patients with this type of cancer only require some minor surgery.

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What Is Metastatic Melanoma?

Metastatic melanoma is an advanced form of melanoma. You may also have heard people refer to this form of cancer as stage 4 melanoma.

In its early stages, melanoma affects the skin and is most commonly indicated by the appearance of a new mole or changes in a pre-existing one. It may affect any area of the body, but in men, it is most commonly encountered on the back, and in women, it is most commonly found on the legs.

When diagnosed at an early stage, treatment is oftentimes successful, and the cancer is able to be removed through surgery. However, if the melanoma is not detected until later on, it can spread into other parts of the body through blood vessels or the lymphatic system. This is known as metastatic melanoma.

Areas of the body that melanoma often spreads to include:

  • Subcutaneous tissue—i.e. the tissue beneath the skin.
  • Lymph nodes.
  • Bone.
  • Lungs.
  • Liver.
  • Brain.

There are four different classifications of metastasized skin cancer you should be aware of. Below, we have included a brief description of each.

Local recurrence

Local recurrence of melanoma is when the cancer regrows within 2 cm of where the primary tumor was surgically removed. This either occurs through the extension of the primary tumor, or as a result of spread through the lymphatic system.

In-transit metastases

Melanoma in-transit metastases refers to the spread of tumors in the skin or subcutaneous tissue more than 2 cm from where the primary tumor was located.

Nodal metastasis

During nodal metastasis, the melanoma spreads through the lymphatic system to the lymph nodes. Affected nodes usually become enlarged and appear as a lump beneath the skin.

Hematogenous spread

Finally, hematogenous spread is when melanoma is spread via the bloodstream. Through this method, the cancer can reach other bodily organs, such as the lungs, liver, or brain.

What Causes Metastatic Melanoma?

Skin cancer is most often caused by exposure to UV light. It is most often attributed to intense sun exposure but can also be caused by the use of tanning beds. Upon exposure to UV light, the radiation causes abnormalities in your DNA, which, in turn, leads to the abnormal development of your skin cells. Repeated sunburn is one of the leading causes of melanoma; this is why it is so important to practice proper skin care.

Certain risk factors do leave you more susceptible to developing this disease. These include:

  • Irregular moles/a high number of moles
  • Cases of melanoma within the family
  • Pale skin
  • Fair hair
  • Skin previously damaged by radiotherapy
If you have moles, it is recommended that you keep an eye on them, making sure to keep out for any new moles appearing or any irregularities in existing moles.

Please note that if none of these risk factors applies to you, that does not mean you are immune from developing melanoma. As such, it is something that you should still remain vigilant against.

For example, even though they have greater natural protection against it, it is still possible for individuals with darker skin to develop melanoma. These individuals may find, however, that the cancer appears on the palms of their hands, the soles of their feet, or beneath their nails.

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What Are the Symptoms of Metastatic Melanoma?

Since melanoma usually presents visually, in the form of abnormal lumps, moles, and skin discoloration, it is often spotted in its early stages. When skin cancer is identified, it is easier to treat, and hopefully will not have the chance to develop into metastatic melanoma.

In some cases, though, melanoma may go undetected. Occasionally a person may develop metastasized skin cancer without any indication of a primary tumor. At this point, they may begin to experience symptoms of metastatic melanoma including:

  • Fatigue
  • Enlarged or painful lymph nodes
  • Unexpected weight loss
  • Loss of appetite
  • Difficult breathing
  • Persistent cough
  • Headaches
  • Seizures
A person will experience different symptoms depending on where the cancer is in their body. For example, melanoma metastasis to bone symptoms include:
  • Aches and pains in the bones
  • Pain or numbness in the back
  • Brittle bones
  • Sleepiness or confusion as a result of changing calcium levels
Melanoma metastasis to lung symptoms include:
  • Coughing, sometimes with blood
  • Chest pain
  • Fluid around lungs
  • Breathlessness
Melanoma metastasis to liver symptoms include:
  • Fatigue or sluggishness
  • Jaundice
  • Lack of appetite
  • Abdominal swelling.
  • Swollen legs
Melanoma metastasis to brain symptoms include:
  • Headaches
  • Seizures
  • Fatigue and sleepiness
  • Forgetfulness
  • Emotional and behavioral dysregulation
  • Nausea and vomiting
  • Paralysis in the limbs

How Is Metastatic Melanoma Diagnosed?

There are a number of different tests you might take to diagnose metastatic skin cancer.

If you show signs of a primary tumor—i.e. abnormal moles, skin discoloration, etc—then your healthcare professional may take a biopsy. This involved a small part of the skin being removed and examined using a microscope to determine whether or not melanoma cells are present. If you test positive for melanoma, then your care team will go on to run tests to determine what stage your cancer is at.

These tests include:

  • Blood tests. Blood tests may be taken to check your overall health and to test for unusual levels of particular substances associated with cancer.
  • CT, MRI, and PET-CT scans. These procedures allow healthcare providers to identify malignant growths without the need for invasive surgery.
  • Genetic testing. When your doctor takes a biopsy of suspected cancerous tissue, they may perform tests on the skin to check for any mutations that may indicate metastasis.
  • Lymph node ultrasounds. Doctors may use ultrasound technology to examine your lymph nodes and detect any abnormalities. If any are found, your healthcare provider may decide to take a biopsy.
  • Sentinel lymph node biopsies (SLNB). If the results from your lymph node ultrasound are inconclusive, you will be injected with a radioactive dye to help your doctor find potentially cancerous lymph nodes for biopsy.

How Is Metastatic Melanoma Treated?

Unfortunately, due to the way it spreads, stage 4 skin cancer is not easy to treat and can very rarely be cured. Rather, the aim of treatment for advanced melanoma is to stop the disease from spreading, thereby increasing the patient’s length of survival. Healthcare professionals also do all that they can to ensure that the patient has a good quality of life and is in as little pain and discomfort as possible.

Some of the treatments a metastatic melanoma patient may receive to help manage their cancer and its symptoms include:

  • Surgery. Primary tumors, metastatic tumors, and cancerous lymph nodes may be removed using surgery. While with stage 4 cancer this is unlikely to cure the disease, it may help to extend your lifespan. It may also help to manage and reduce certain symptoms. Usually, surgical procedures are made in conjunction with other forms of treatment.
  • Chemotherapy and radiation. These techniques are not as popular as they once were. This is because alternative therapies, such as immunotherapy and targeted therapies, have proven themselves to be more effective. That said, chemotherapy and radiation still may be used to kill melanoma cells and prevent the cancer from recurring.
  • Immunotherapy. This treatment method provides a boost to the patient’s immune system, helping the body identify and attack melanoma cells. When used over an extended period, immunotherapy drugs can have some significant side effects, but they can also help to shrink cancerous tumors.
  • Targeted therapies. Your doctor may use drugs designed to attack melanoma cells with specific mutations. These cancerous cells are selectively destroyed, meaning that your body’s healthy cells will not be harmed in the process.

It is likely that a combination of the above methods will be used in your treatment.

The exact combination of treatments you and your healthcare provider choose will be decided with your particular needs in mind. You will be given the chance to speak with them at length about the different options available to you and should use that opportunity to ask as many questions as possible to help you feel more comfortable. It’s important that you feel fully informed of the benefits and risks of your proposed healthcare plan.

Also, keep in mind that your healthcare plan is not set in stone; rather, it is dynamic, and can be adapted according to your changing needs.

Find Support for You and Your Loved Ones

If you or a loved one has a diagnosis of stage 4 melanoma, you are no doubt going through an especially difficult time right now. Feelings of grief, stress, and anxiety for the future no doubt worsen an already challenging situation. Both patients and carers alike, therefore, need a great deal of support to get through these trying times.

On top of the emotional needs of the patient and their loved ones, there are concerns regarding physical care. As the patient draws closer to the end of their life, they may need more supervision. It can be difficult for carers to provide the full-time care often required by end-of-life cancer patients.

If you or a loved one has received a metastatic melanoma diagnosis and believe that you would benefit from additional support, why not reach out to All American Hospice today? When you hire our hospice services, you have access to 24/7 care from nurses and hospice aides, as well as whatever medical equipment and medication you require to live out your final days in comfort. With support from our network of chaplains, social workers, and volunteers, in addition to a full-time care program planned out with your physician, your every need will be taken care of during this difficult time.

Living with metastatic melanoma or any other cancer diagnosis is never easy, even with full-time care. But our caring, experienced professionals will do all that they can to take some of the stress off the shoulders of patients and their carers, ensuring they can enjoy what time they have left together.

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