Advanced melanoma

What is advanced melanoma?

Melanoma is a cancer that usually starts in the skin. It may start as a new mole or in a mole you already have.

Advanced melanoma is when melanoma cells spread from where they started (the primary melanoma) to other parts of the body. It is also called metastatic melanoma.

Melanoma cells can travel through the blood or the lymphatic system.

When the cells reach another part of the body, they may begin to grow and form another tumour. This is called a secondary melanoma or a metastasis.

The secondary cancer is made up of melanoma cells. Doctors treat secondary melanoma as melanoma, no matter where it is in the body. For example, they treat a secondary melanoma tumour in the lung as melanoma, not as lung cancer.

Sometimes melanoma has already spread to another part of the body when it is first diagnosed. Less commonly, some people are diagnosed with advanced melanoma without ever finding the primary melanoma.

Advanced melanoma is usually stage 4 melanoma. If stage 3 melanomas cannot be removed with surgery, they may be described and treated as advanced melanoma.

We have more information about:

melanoma
melanoma that has come back in the same area (recurrent melanoma)
eye cancer (ocular melanoma)
anorectal melanoma.

Related pages

What is cancer?

Booklets and resources

Symptoms of advanced melanoma

Advanced melanoma can cause different symptoms. These depend on where the melanoma has spread to. There may also be some general symptoms. If you are worried about advanced melanoma, talk to your doctor or nurse and get advice.

We have more information about the signs and symptoms of advanced melanoma.

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Do I have cancer?

Causes of advanced melanoma

The biggest risk factor for melanoma is exposure to ultraviolet light (UV light). This can be through sunlight or sunbeds. Like most cancers, getting older is also a risk factor. But melanoma is more common in younger people than some other cancers.

We have more information about the causes and risk factors of melanoma.

Diagnosis of advanced melanoma

If you have already had treatment for melanoma, you may have check-ups at a clinic. Sometimes advanced melanoma is diagnosed through tests you have at the clinic. Or your doctor may arrange tests to find out what is causing your symptoms.

If you notice new symptoms between check-ups, contact your cancer doctor or nurse. They may arrange some tests for you. Do not wait until your next appointment.

Sometimes melanoma has already spread to another part of the body when it is first diagnosed. Or tests after the melanoma has been removed may show it has spread.

A small number of people not previously diagnosed with melanoma are diagnosed with advanced melanoma. In this situation, doctors look for the primary melanoma and arrange any tests you may need.

Occasionally, they cannot find the primary melanoma. This is called melanoma of unknown primary. Doctors are not certain why this happens. It may be because the person’s immune system helped shrink the primary melanoma. Or the primary melanoma may have been removed for another reason.

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Cancer and your emotions

Tests for advanced melanoma

The tests you have depend on your situation. If you are newly diagnosed with melanoma, you may start with tests on the nearby lymph nodes. If the melanoma has spread to the lymph nodes, you may have further tests.

Tests will check whether melanoma has spread to other parts of the body. They may include:

Blood tests

You will have a blood test to check your general health and how well your bone marrow, kidneys and liver are working. Bone marrow is where blood cells are made.
CT scan

A CT scan takes a series of x-rays. These build up a detailed picture of the inside of the body.
MRI scan

An MRI scan uses magnetism to build up detailed pictures of your body.
Ultrasound scan

Ultrasound scans use sound waves to build up a picture of a specific area inside the body.
Bone scan

A bone scan shows abnormal areas of bone. You have a small amount of a radioactive substance injected into a vein.
PET scan

A PET scan uses low-dose radioactive sugar to measure the activity of cells in the body.

Tests on the melanoma cells

Your doctor may arrange tests to look for certain gene changes (mutations) in the melanoma cells. The results of this type of testing tell your cancer doctor which targeted or immunotherapy drugs are likely to work for you if you should need them.

Related pages

Stages of advanced melanoma

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

Advanced melanoma is stage 4 melanoma. If a stage 3 melanoma cannot be removed with surgery, it may be treated as advanced melanoma.

Stage 4 means the melanoma has spread to other areas of the body such as:

distant areas of skin
distant lymph nodes
the lungs, liver, bones or brain.

Treatment for advanced melanoma

A team of specialists will meet to discuss the best possible treatment for you. This team is called a multidisciplinary team (MDT).

Your cancer doctor and nurse will explain the different treatments and their side effects. They will also talk to you about things you may want to think about when making treatment decisions. You and your doctor can then decide on the best treatment for you.

The aim of treatment for advanced melanoma is to control the cancer and help you to live for longer. The main treatments are immunotherapy and targeted therapy drugs, and targeted treatments are the most effective treatments for advanced melanoma. Many people are now living for a longer time with advanced melanoma.

Depending on your situation, you may have one or more types of treatment. Sometimes you may have treatment for advanced melanoma as part of a clinical trial.

Your doctor can also give you treatments or drugs to control different symptoms you may have.

The main treatments for advanced melanoma are:

Immunotherapy

Immunotherapy use the body’s immune system to recognise and kill cancer cells. They help control or shrink the growth of advanced melanoma.
Targeted therapy

Targeted therapy drugs target something in or around the cancer cell that is helping it grow and survive. They help control or shrink the growth of advanced melanoma.

Immunotherapy and targeted therapy are the most effective treatments for advanced melanoma. They may cause serious side effects. But your doctor and nurse will explain these so that you know what to look out for. This means side effects can be treated earlier before they become serious.

Other treatments are sometimes used:

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells. If melanoma has spread to the brain, bones or skin you may have radiotherapy to help control symptoms.
Surgery

You may have surgery to remove a tumour that has spread to another part of the body. This is only usually helpful if a tumour is small or they are all in the one area. For example, if melanoma has spread to the brain or lung, you may have surgery to remove the tumour.

You may have surgery to remove affected areas of skin or lymph nodes far away from where the melanoma started.
Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You do not usually have chemotherapy to treat advanced melanoma. If immunotherapy or targeted therapy drugs are not suitable or are no longer controlling the melanoma you might have chemotherapy.

You may have the following treatments to treat affected areas of skin or lymph nodes that cannot be removed with surgery. Some of these are only available at certain hospitals. Not all of them are available in every area of the UK. Your doctor or nurse can give you more information.

Chemotherapy into a limb

You may have chemotherapy directly into a limb. You may have this to treat clusters of melanoma in the arm or leg where the melanoma started. Chemotherapy into a limb is also called isolated limb perfusion (ILP) or isolated limb infusion (ILI).
Laser therapy

You may have laser therapy to destroy small areas of melanoma on the skin.
Electrochemotherapy

Electrochemotherapy is uses chemotherapy and a small electrical current to treat small areas of melanoma on the skin.
T-VEC

T-VEC is a type of immunotherapy. You have it as an injection into an area of melanoma on the skin or in the lymph nodes. You only have it if the melanoma has not spread to other areas such as the bones or the brain.
Imiquimod

Imiquimod is a cream that uses your body’s immune system to get rid of the cancer cells. You sometimes have it to treat small areas of melanoma on the skin.

You may have some treatments as part of a clinical trial.

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Living with advanced melanoma

You can have treatments to control symptoms and side effects alongside treatments such as immunotherapy or targeted therapy. Always tell your doctor or nurse about side effects or symptoms as there are things they can do to help.

Controlling side effects and symptoms is an important part of your care. You may see a doctor or nurse who are experts in symptom control. They may be based in hospital or in the community as part of a palliative care team. We have more information about controlling symptoms and side effects of advanced melanoma.

Your feelings

You may have a mix of feelings when coping with advanced melanoma. Everyone has their own way of dealing with illness and the different feelings they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.

Body image

If melanoma comes back in the skin or lymph nodes, it may cause nodules or skin lesions. Some people may have visible scarring or skin changes. All this can affect body image. Talk to your nurse if this is a concern for you. There are different things that can help to improve body image changes.

Sex

Cancer and its treatment can also cause physical and emotional changes that may affect your sex life. You can read more about coping with these and things that may help in our information on cancer and sex.

Follow-up care

You will have regular follow-up appointments with your cancer specialist or specialist nurse. They will check whether you have any side effects and whether symptoms have improved.

If you are having immunotherapy or targeted therapy, you may have regular scans to check how well treatment is working. You may have scans, x-rays or blood tests.

Your doctor or nurse can talk to you about symptoms or side effects to look out for. You will be given contact details for your specialist nurse. You can contact them for advice and support.

Getting support

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line for free on 0808 808 00 00.
Chat to our specialists online.
Visit our melanoma forum to talk with people who have been affected by melanoma, share your experience, and ask an expert your questions.

The following organisations also offer information and support:

Melanoma Focus

Melanoma Focus provides information, guidance and support for patients, carers and healthcare professionals. It has a free helpline answered by expert skin nurses. It also has a Melanoma TrialFinder for melanoma trials in the UK.
Melanoma UK

Melanoma UK provides support and information for patients, carers and healthcare professionals. It provides a skin check toolkit.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

Related pages

Finishing cancer treatment

About our information

References

Below is a sample of the sources used in our advanced melanoma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Keilholz U, Ascierto PA, Dummer R, et al. ESMO consensus conference recommendations on the management of metastatic melanoma: under the auspices of the ESMO Guidelines Committee. Annals of Oncology. 2020. 31 (11): 1435-1448 [accessed May 2022].

Peach H, Board R, Cook M, et al. Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73, 1, 36-42 [accessed May 2022].

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Samra Turajlic, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.