How Do You Know If Melanoma Has Spread

When Should I Call My Doctor

You should have a skin examination by a doctor if you have any of the following:

• A personal history of skin cancer or atypical moles .
• A family history of skin cancer.
• A history of intense sun exposure as a young person and painful or blistering sunburns.
• New or numerous large moles.
• A mole that changes in size, color or shape.
• Any mole that itches, bleeds or is tender.

A note from Cleveland Clinic

Receiving a diagnosis of melanoma can be scary. Watch your skin and moles for any changes and seeing your doctor regularly for skin examinations, especially if youre fair-skinned, will give you the best chances for catching melanoma early when its most treatable.

Last reviewed by a Cleveland Clinic medical professional on 06/21/2021.

References

Stress Hair Loss And Body Image

• The diagnosis of melanoma and the need for treatment can be very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques may also help reduce your stress.
• Hair loss can be emotionally distressing. Not all chemotherapy medicines cause hair loss. And some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect with the medicines you will receive.
• Your feelings about your body may change following a diagnosis of melanoma and the need for treatment. Adapt to your body-image changes by talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer more support and information.

Having cancer can change your life in many ways. For help in managing these changes, see the topic Getting Support When You Have Cancer.

Biological Therapies And Melanoma

Biological therapies are treatments using substances made naturally by the body. Some of these treatments are called immunotherapy because they help the immune system fight the cancer, or they occur naturally as part of the immune system.;There are many biological therapies being researched and trialled, which in the future may help treat people with melanoma. They include monoclonal antibodies and vaccine therapy.;

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Symptoms If Cancer Has Spread To The Brain

You might have any of the following symptoms if your cancer has spread to your;brain:

• headaches
• weakness of a part of the body
• fits
• personality changes or mood changes
• eyesight changes

• J Tobias and D HochhauserJohn Wiley and Sons Ltd

• TNM Staging ChartsLippincott Williams and Wilkins, 2009

• Improving supportive and palliative care for adults with cancerNational Institute for Clinical Excellence , 2004

• Oxford Textbook of Palliative MedicineEds D Doyle and othersOxford Universty Press, 3rd edition 2005;

• Cancer and its Management;;J;Tobias and D HochhauserWiley;Blackwell, 2015

Can Metastasis Be Prevented

Melanoma can spread “silently,” meaning that you may not experience any symptoms of metastasis. Therefore, if you’ve been treated for early-stage melanoma in the past, it is extremely important to perform regular self-examinations of your skin and lymph nodes, to keep all your appointments for checkups, and practice sun safety. There is nothing else an individual can do to prevent metastasis from being very diligent.

Catching a recurrence early greatly increases your chances of successful treatment. If the melanoma does spread, it is important to remain positive: remember that while the average prognosis is poor, some people do survive stage IV melanoma.

Skin Cancer Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

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What Are The Signs Of Melanoma

Knowing how to spot melanoma is important because early melanomas are highly treatable. Melanoma can appear as moles, scaly patches, open sores or raised bumps.

Use the American Academy of Dermatology’s “ABCDE” memory device to learn the warning signs that a spot on your skin may be melanoma:

• Asymmetry: One half does not match the other half.
• Border: The edges are not smooth.
• Color: The color is mottled and uneven, with shades of brown, black, gray, red or white.
• Diameter: The spot is greater than the tip of a pencil eraser .
• Evolving: The spot is new or changing in size, shape or color.

Some melanomas don’t fit the ABCDE rule, so tell your doctor about any sores that won’t go away, unusual bumps or rashes or changes in your skin or in any existing moles.

Another tool to recognize melanoma is the ugly duckling sign. If one of your moles looks different from the others, its the ugly duckling and should be seen by a dermatologist.

Different Kinds Of Skin Cancer

There are many types of skin cancer. Some are very rare. Your doctor can tell you more about the type you have.

The two most common kinds of skin cancers are:

• Basal cell cancer, which starts in the lowest layer of the skin
• Squamous cell cancer, which starts in the top layer of the skin

Another kind of skin cancer is called melanoma. These cancers start from the color-making cells of the skin . You can read about melanoma in If You Have Melanoma Skin Cancer.

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Red Flag #: Swollen Lymph Nodes

If melanoma spreads, it often goes to the lymph nodes first, says Melinda L. Yushak, M.D., assistant professor of hematology and medical oncology at Emory University School of Medicine in Atlanta. The cancer cells will first travel to the nodes closest to the original tumor, she says. Lymph nodes are located throughout your entire body, but large clusters are found in the neck, underarms, chest, abdomen, and groin. If the cancer has made its way to the lymph nodes, it usually wont be painful, but theyll feel swollen or even hard to the touch, Dr. Zaba says.

Can Changing My Diet Help Prevent Melanoma

The American Cancer Society advocates eating a plant-based diet over an animal-based diet as part of a healthy plan to avoid all cancers. Growing evidence suggests that plants pack a powerful punch in any fight against cancer because they’re nutritious, cholesterol-free and fiber-rich.

Theres no doubt that a healthy diet can protect your immune system. Having a strong immune system is important to help your body fight disease. Some research has shown that a Mediterranean diet is a healthy choice that may help prevent the development of cancer. Talk to your healthcare provider about the role food plays in lowering your cancer risks.

Some skin and immune-system healthy foods to consider include:

• Daily tea drinking: The polyphenols in tea help strengthen your immune system. Green tea contains more polyphenols than black tea.
• High vegetable consumption: Eating carrots, cruciferous and leafy vegetables is linked to the prevention of cutaneous melanoma.
• Weekly fish intake: Study participants who ate fish weekly seemed to avoid developing the disease when compared to those who did not eat fish weekly.

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Questions To Ask The Doctor

• How far has the melanoma spread under my skin?
• Has it spread anywhere else?
• What treatment do you think is best for me?
• Whats the goal of this treatment? Do you think it could cure the cancer?
• Will treatment include surgery? If so, who will do the surgery?
• What will the surgery be like?
• Will I need other types of treatment, too?
• Whats the goal of these treatments?
• What side effects could I have from these treatments?
• What can I do about side effects that I might have?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• Whats the next step?

Red Flag #: Chest Pain And Trouble Breathing

Melanoma is also known to spread to the lungs, though Dr. Zaba notes that most people dont experience noticeable symptoms in the lungs until a tumor has gotten pretty large. A cough that just wont quit or recurring chest infections can signal that the cancer has traveled to the lungs, Dr. Polsky says. Shortness of breath or trouble breathing can also be a red flag.

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Mouse Models Mimic Metastasis Of Human Melanoma

Metastasis is a highly inefficient process in that the vast majority of cancer cells that try to migrate die before they ever have an opportunity to form a tumor, Dr. Morrison said.

Dr. Morrisons team found previously that one factor limiting the survival of melanoma cells circulating in the blood is that the cells experience a high level of oxidative stress. Oxidative stressan imbalance between free radicals and antioxidants in the bodycauses chemical reactions that can damage proteins, DNA, and lipids in cells and disrupt normal cell processes. However, precisely how oxidative stress kills circulating melanoma cells was not known.

For their studies, the team used a mouse model of metastasis created by transplanting melanoma cells from humans beneath the skin of specially bred mice with weakened immune systems. These mice were used to avoid having the transplanted human cells seen as foreign and attacked by the immune system. The team also used a second mouse model created by transplanting mouse melanoma cells into mice with normal immune systems.

Comparing these two mouse models let the researchers control for potential effects of the immune system on the spread of melanoma, Dr. Salnikow explained.

The study was supported in part by NCIs Patient-Derived Models of Cancer program, which promotes the development of animal models that more closely mirror how tumor cells behave in humans.

What Is Melanoma Of The Head And Neck

Melanoma is a cancer that arises from melanocytes, the cells that give skin its pigment or color. Melanoma most commonly occurs in skin cells, but can rarely also occur in mucous membranes of the respiratory, gastrointestinal, genital or urinary organs. Melanoma arising in skin cells is caused by ultraviolet radiation from exposure to the sun and tanning beds.

Melanoma is the least common form of skin cancer, but it is responsible for more deaths per year than all other skin cancers combined. Melanoma is also more likely than other skin cancers to spread, and may be harder to control. However, approximately 75% of melanomas are found before they have spread, and can be cured with treatment. Mucosal melanomas make up 1% of all melanomas, and are more likely to spread to other sites

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Can You Prevent Melanoma

The best way to prevent all kinds of skin cancer, including melanoma, is to protect yourself whenever you are out in the sun.

• Try to stay out of the sun during the middle of the day .
• Wear sun-protective clothes when you are outside, such as a hat that shades your face, a long-sleeved shirt, and long pants.
• Use sunscreen every day. Your sunscreen should have an SPF of least 30. Look for a sunscreen that protects against both types of UV radiation in the sun’s raysâUVA and UVB. When you are outdoors for long periods of time, reapply sunscreen every 2 hours.
• Take extra care to protect your skin when you’re near water, at higher elevations, or in tropical climates.
• Avoid sunbathing and tanning salons.

Check your skin regularly for odd marks, moles, or sores that will not heal. Check all of your skin, but pay extra attention to areas that get a lot of sun, such as your hands, arms, and back. Ask your doctor to check your skin during regular physical exams.

Are There Different Kinds Of Skin Cancer

There are many types of skin cancer. Your doctor can tell you more about the type of skin cancer you have.

Basal cell and squamous cell skin cancers are much more common than melanoma and dont often spread to other parts of the body. Melanoma is more deadly because it is more likely to spread to other parts of the body.

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The Braf Gene Mutation And Melanoma

Roughly half of all documented melanoma cases present with mutations in the BRAF gene. The melanoma cells that have these changes create a BRAF protein, which aids them in their growth. If a person with the BRAF gene mutation has melanoma, knowing about the mutation is of great benefit for treatment because healthcare providers can use targeted therapy to inhibit the BRAF gene mutation from aiding in the growth of the cancer.

If a diagnosis of melanoma is already established, the healthcare provider will look at two factors to determine how advanced a stage 4 melanoma has become: the location of the distant tumors and an elevated level of serum lactate dehydrogenase , which is an enzyme responsible for turning sugar into energy. The higher the LDH level in body fluids, the more damage the cancer has done.

Red Flag #: Headaches Or Visual Changes

Just like the liver, not everyone will notice symptoms of melanoma spreading to the brain. But when symptoms do show up, its usually in the form of headaches, problems with eyesight, paralysis on one side of the body, or seizures. If someone simply has a headache, that doesnt mean they have advanced stage melanoma, Dr. Yushak says. But if its a headache thats not going away after a week, and you never have headaches, then thats something that definitely needs to be checked out.

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When Melanoma Spreads To The Skin And Lymph Nodes

If melanoma spreads, there’s a 50/50 chance that it will spread first to other areas of your skin or to the lymph nodes near your original melanoma.

Signs that it has spread to skin or to areas just under your skin can include hard bumps that crack open and bleed. The bumps may be black or red. You may also have firm, painless lumps under your skin. Sometimes they are skin-colored; other times they’re bluish in color.

If melanoma spreads to a lymph node, you may notice a firm, hard swelling. If a swollen lymph node presses on a nerve, the lymph node may be painful. If melanoma blocks a lymph vessel, fluid can build up behind that area. This causes swelling, a condition known as . You may feel a tight or heavy sensation in the swollen area.

Recognizing The Signs And Symptoms

The most noticeable sign of melanoma is the appearance of a new mole or a change in an existing mole or birthmark. People should be aware of any pigmented areas on the skin that appear abnormal in color, shape, size, or texture.

People with stage 4 melanoma may also have ulcerated skin, which is skin with tiny breaks on the surface. These ulcerations can bleed.

Another sign is swollen or hard lymph nodes, which a doctor can confirm by carrying out a physical examination. Other tests include blood tests and imaging scans to confirm the presence of cancer and check how much it has spread.

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Risk Of Further Melanomas

Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups.;Your doctor will decide how often you will need check-ups everyone is different. They will become less frequent if you have no further problems.;After treatment for melanoma it is important to limit exposure to the sun’s UV radiation.;As biological family members usually share similar traits, your family members may also have an increased risk of developing melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using a combination of sun protection measures during sun protection times.;It is important to monitor your skin regularly and if you notice any changes in your skin, or enlarged lymph glands near to where you had the cancer, see your specialist as soon as possible.;

Symptoms Of Metastatic Melanomas

Melanoma usually is found in early stages, before its become metastatic. If you notice any abnormal moles or discolorations on your skin, dont hesitate to reach out to your doctor. This is especially important for those with many risk factors. Melanoma is more treatable at early stages, so early identification may prevent metastatic melanoma from developing.

Though a primary tumor is typically found, its possible that metastatic melanoma is detected elsewhere in the body and causes symptoms without any signs of a primary tumor.

Metastatic melanoma symptoms and signs may include:

• Fatigue

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Additional Evaluation After A Diagnosis Of Melanoma

After an initial diagnosis of melanoma, you will be referred to a specialist. The doctor will take a complete medical history, noting any symptoms or signs,;

and perform a complete physical examination, including a total skin examination;and lymph node examination. The focus of these examinations is to identify risk factors and signs or symptoms that may indicate melanoma has spread beyond the original site.

The extent of the initial evaluation is based on the primary melanomas risk of recurrence. For most people with thin melanoma , no further search for metastases or spread is generally necessary. For people with higher-risk melanoma, more extensive testing, such as imaging tests described below, may be considered, but this usually occurs after surgical management has been completed. Therefore, the extent of the initial evaluation for a person with newly diagnosed melanoma is based on the stage of melanoma and discussions with the team of doctors.

Depending on the results of the evaluation, including the pathology report of the primary melanoma tumor, further testing for high-risk or later-stage melanoma may include the following:

Lymphatic mapping and sentinel lymph node biopsy

Lymphatic mapping and SNB are usually recommended for people with a melanoma that is more than 1.0 mm thick or has ulceration.

This information is based on the ASCO guideline, “Sentinel Lymph Node Biopsy for Melanoma.” Please note that this link takes you to another ASCO website.