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.
How The Stage Is Determined
Once you have been diagnosed with squamous cell carcinoma, your doctor will want to determine its stage. While the risk of this type of cancer spreading is low, determining the stage will help your doctor develop the best treatment plan.
The TNM system is a uniform system for staging many types of cancer. TNM stands for:
- T is for tumor: How far has the primary tumor grown through the layers of skin or to nearby tissues?
- N is for nodes: Have cancer cells spread to the lymph nodes near the tumor?
- M is for metastasis: Has the cancer metastasized to distant sites in the body such as the lungs or liver?
Skin Cancer Doctor Discussion Guide
How Is Skin Cancer Diagnosed
Your doctor or dermatologist will first conduct a physical examination by looking at your skin to identify any suspicious spots using a dermatoscope .
Its not always possible to tell from looking at it whether a spot or lump is cancerous or not. So your doctor or dermatologist may take a skin biopsy. This is where part of, or all of, your spot is removed and sent for further study under a microscope.
Some smartphone apps allow you to photograph your skin and compare photos over time. While they can be a good reminder to check your skin and record details, they shouldnt replace a visit to the doctor. See a doctor if youre concerned about any spots or moles on your skin.
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Lymph Nodes As A Stopover On A Cancer Cells Journey
Movement of melanoma cells into lymph nodes is not necessarily an endpoint, but rather a stopover on the cells journey elsewhere, wrote Barbara Grüner, Ph.D., of University Hospital Essen in Germany, and Sarah-Maria Fendt, Ph.D., of the Leuven Center for Cancer Biology in Belgium, in .
These results provide a first step towards understanding the protective environment of lymph, Drs. Grüner and Fendt wrote. To what extent findings apply to tumor types other than melanoma, and to humans, remains to be determined. If the results are relevant to human disease, innovative ways must be found for them to have a therapeutic impact.
Dr. Morrisons team is already looking into existing drugs that might make cancer cells more vulnerable to ferroptosis and block the protective effects of lymph, he said. The idea would be to see if such a drug could be given early in the disease course of melanoma to prevent it from spreading.
If we can find a therapy that blocks disease progression in mice, then we would go into clinical trials to see if it works in humans, he added.
Dr. Salnikow said multiple approaches will likely be needed to prevent the spread of melanoma, because different biological factors may be important for metastasis in different people.
One of the interesting questions to answer is whether MCT1 is also helping to protect these melanoma cells metastasizing through lymph, and were doing those experiments now, Dr. Morrison said.
Red Flag #: Bone Pain Or Fractures
The bones are considered a late-stage site of melanoma metastasestypically, it doesnt spread to the bones until its already spread to another area of the body first. Melanoma can cause pain in the bones where its spread, and some peoplethose with very little body fat covering their bonesmay be able to feel a lump or mass. Metastatic melanoma can also weaken the bones, making them fracture or break very easily. This is most common in the arms, legs, and spine. If you feel any sharp, sudden, or new pains that wont go away, talk to your doctor.
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Treatment Of Metastatic Melanoma
Metastatic melanomas can be difficult to treat. The five-year survival rate for people diagnosed with melanoma that has spread to nearby lymph nodes is 66 percent, according to the American Cancer Society. When cancer has spread to distant parts of the body, there may also be other metastases too small to detect by scans. For people diagnosed with stage 4 melanoma, or melanoma that has spread to distant parts of the body, the five-year survival rate is 27 percent.
For stage 3 and 4 melanomas, the following treatments may be used:
Multiple therapies can be used at any given time, and your care plan is a dynamic process. You and your care team should discuss all the options and decide on a treatment plan. Each treatment has different side effects, and its important to feel fully informed of all the associated risks. Other medications and options may help manage the symptoms of your cancer treatment, so you can live the highest quality of life possible throughout the course of your treatment and disease.
What Is Skin Cancer
Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control.
Skin cancer cells can sometimes spread to other parts of the body, but this is not common. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin.
Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, its still called skin cancer.
Ask your doctor to use this picture to show you where your cancer is
How Fast Does Squamous Cell Carcinoma Spread
Squamous cell carcinoma rarely metastasizes , and when spreading does occur, it typically happens slowly. Indeed, most squamous cell carcinoma cases are diagnosed before the cancer has progressed beyond the upper layer of skin. There are various types of squamous cell carcinoma and some tend to spread more quickly than others.
How Common Is Melanoma
Melanoma accounts for only about 1% of all skin cancers, but causes the great majority of skin cancer-related deaths. Its one of the most common cancers in young people under 30, especially in young women.
Melanoma incidence has dramatically increased over the past 30 years. Its widely accepted that increasing levels of ultraviolet exposure are one of the main reasons for this rapid rise in the number of melanoma cases.
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Symptoms Of Metastatic Melanoma Other Than A Mole
Other symptoms of this type of cancer may not appear until a later stage, when the melanoma has metastasized to another area of the body. Metastatic melanoma most often spreads to the lymph nodes, brain, bones, liver or lungs, and the additional symptoms experienced at this late stage will depend on where the melanoma has spread. For example:
- Lungs A persistent cough or shortness of breath
- Brain Headaches or seizures
- Lymph nodes Swelling of the lymph nodes
- Liver Loss of appetite or unexplained weight loss
- Bone Bone pain or unusual fractures
Diagnosis Of Metastatic Melanoma
Your care team may use several tests to diagnose metastatic melanoma.
If theres evidence of a primary tumor, a biopsy may be taken. For this, a small section of suspected cancerous skin is removed with a razor, scalpel or small punch tool. The removed tissue is examined under a microscope to determine whether its melanoma.
Additional tests are needed to determine whether the cancer is metastatic melanoma, or if theres no visible primary tumor. To test for metastatic melanoma, or melanoma that has spread to lymph nodes or distant parts of the body, your care team may perform the following tests.
- Lymph node mapping and sentinel lymph node biopsy : Your doctor may perform a physical exam of your lymph nodes and check for swelling or physical masses. If no tumors are found , an SLNB may be done. For an SLNB, a radioactive dye is injected to locate the primary tumor. Then, the doctor will remove the lymph nodes that the dye traveled to and check them for melanoma.
- Computed tomography scan, positron emission tomography scan, magnetic resonance imaging scan or ultrasound exam: Each of these scans is a noninvasive way to look inside your body and check for tumors.
- Blood chemistry studies: Cancer may cause elevated or abnormal levels of certain substances in your blood. A laboratory test can identify if your blood chemistry shows signs of a cancerous tumor.
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Staging For Merkel Cell Cancer
Doctors use the TNM system to describe the stage of Merkel cell cancer. Doctors use the results from diagnostic tests and scans to answer these questions:
Tumor : How large is the primary tumor? Where is it located?
Node : Has the tumor spread to the lymph nodes? If so, where and how many?
Metastasis : Has the cancer spread to other parts of the body? If so, where and how much?
The results are combined to determine the stage of Merkel cell cancer for each person.
There are 5 stages: stage 0 and stages I through IV . The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
Stage 0: This is called carcinoma in situ. Cancer cells are found only in the top layers of the skin. The cancer does not involve the lymph nodes, and it has not spread.
Stage I: The primary tumor is 2 centimeters or smaller at its widest part. The cancer has not spread to the lymph nodes or to other parts of the body.
Stage IIA: The tumor is larger than 2 cm and has not spread to the lymph nodes or other parts of the body.
Stage IIB: The tumor has grown into nearby tissues, such as muscles, cartilage, or bone. It has not spread to the lymph nodes or elsewhere in the body.
Stage III: The cancer has spread to the lymph nodes. The tumor can be any size and may have spread to nearby bone, muscle, connective tissue, or cartilage.
Stage IV: The tumor has spread to distant parts of the body, such as the liver, lung, bone, or brain.
Other Tests You May Get:
Before, during, or after lymph node biopsy, your doctor might order one or more of the following imaging tests, too:
Ultrasound: This uses sound waves to create a picture of the inside of your body, including collections of lymph nodes. The image can help the doctor determine if melanoma has spread to a nearby lymph node before surgery, and it can help them guide a fine needle aspiration of a lymph node.
CT scan : This is a powerful X-ray that makes detailed pictures inside your bodyâs soft tissues. You lie on a table, and it rotates around you taking several pictures. If the melanoma has spread, it can show the size of a tumor. Sometimes doctors order a âcontrast mediumâ or special dye to provide more detail on the image. Before a contrast scan, you’ll get the dye injected into your vein or as a liquid to swallow. A CT scan takes longer than a typical X-ray — usually anywhere from 15 minutes to an hour.
MRI : It uses powerful magnets and radio waves to make pictures of organs and structures inside your body. For melanoma, an MRI can detect the tumor and measure its size. Like the CT scan, your doctor may order a scan with contrast to show greater detail. An MRI can take about an hour.
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What If I Have Metastatic Melanoma Symptoms
Whether you have a suspicious mole or are experiencing some symptoms of advanced-stage melanoma, it is important to consult with a physician to receive an accurate diagnosis, as many other conditions can cause similar symptoms. At Moffitt Cancer Center, we provide a comprehensive range of screening, diagnostic, treatment and supportive care services for patients with melanoma and other types of cancer. Within our Cutaneous Oncology Program, our multispecialty team includes surgeons, dermatologists, medical oncologists and other experts who work together as a tumor board to ensure our patients receive the best possible treatment and care.
If you would like to schedule an appointment at Moffitt to discuss your metastatic melanoma symptoms, call or fill out a new patient registration form online. We do not require a referral to schedule an appointment.
Oral Medications For Advanced Bcc
It is rare for skin cancer to reach advanced stages, but when it does, oral medications may help. In addition to chemotherapy, targeted drugs may be used to treat advanced skin cancer. Targeted therapy means that the medication is able to directly target the cancer cells without destroying healthy cells. This can help to reduce side effects from treatment.
Vismodegib and sonidegib are hedgehog pathway inhibitors that work to prevent cancer cells from growing and spreading. The capsules are taken once per day and may be considered after surgery and other treatments. These medications come with several possible side effects and should never be taken during pregnancy since they can affect fetal growth.
Cetuximab is an EGFR inhibitor that can help to stop the spread of cancerous squamous cells. Its possible side effects include skin infections, diarrhea, mouth sores, and loss of appetite.
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Comparing Metastatic Melanoma Cells In Lymph Versus Blood
Most studies of cancer cell metastasis in people have focused on cells circulating in the blood. Thats because its much easier to collect patient blood samples than it is to collect samples of lymph, the clear fluid that carries immune cells through vessels of the lymphatic system, Dr. Morrison said.
Dr. Morrisons team found that human melanoma cells injected into lymph nodes in the mice were more likely to form distant tumors than melanoma cells injected into blood.
To study the role of lymph in metastasis, lead investigator Jessalyn Ubellacker, Ph.D., a postdoctoral researcher in Dr. Morrisons lab, figured out how to collect melanoma cells from lymph in mice. This allowed the team to do the first side-by-side comparison of melanoma cells spreading through lymph and through blood in the same animal, Dr. Morrison said.
Next the team found that melanoma cells in lymph experienced less oxidative stress than melanoma cells in blood. That offered a potential explanation for why melanoma cells from lymph nodes were surviving better and better able to form a tumor, Dr. Morrison said.
Further experiments showed that melanoma cells in blood are vulnerable to ferroptosisa form of cell death that occurs when lipids damaged by oxidative stress build up in the outer membrane of a cell. By contrast, melanoma cells from lymph nodes were protected from ferroptosis.
Stages Of Melanoma Skin Cancer
Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the skin have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome .
The most common staging system for melanoma skin cancer is the TNM system. For melanoma skin cancer there are 5 stages stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.
When describing the stage, doctors often use the words early stage, locoregional or metastatic.
Early stage means that the cancer is only in where it started and has not spread to other parts of the body. It includes stage 0, stage 1A, stage 1B, stage 2A, stage 2B and stage 2C melanoma skin cancers.
Locoregional means the cancer has spread to nearby lymph nodes, or it has spread to nearby areas of skin or lymph vessels. It includes stage 3 melanoma skin cancer.
Metastatic means that the cancer is in a part of the body farther from where it started. It includes stage 4 melanoma skin cancer.
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What Is A Melanocyte
Melanocytes are skin cells found in the upper layer of skin. They produce a pigment known as melanin, which gives skin its color. There are two types of melanin: eumelanin and pheomelanin. When skin is exposed to ultraviolet radiation from the sun or tanning beds, it causes skin damage that triggers the melanocytes to produce more melanin, but only the eumelanin pigment attempts to protect the skin by causing the skin to darken or tan. Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes in the melanocytes, resulting in uncontrolled cellular growth.
Naturally darker-skinned people have more eumelanin and naturally fair-skinned people have more pheomelanin. While eumelanin has the ability to protect the skin from sun damage, pheomelanin does not. Thats why people with darker skin are at lower risk for developing melanoma than fair-skinned people who, due to lack of eumelanin, are more susceptible to sun damage, burning and skin cancer.