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
Can You Die From Nail Cancer
Nail cancer is not a death sentence. If treated on time, it wont lead to any serious complications. If left understand, it may develop to stage IV, where the cancer spreads to other parts of the body. If still not treated as soon as possible, the cancer could spread to other delicate organs that could lead to death.
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How Dangerous Is Melanoma Its All A Matter Of Timing
Skin cancer holds the unfortunate distinction of being the worlds most common cancer. Though its prevalence around the globe is disturbing, there is some good news: When caught early, skin cancers are almost always curable.
You might already know that catching a cancer early means a more favorable prognosis. But it can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Melanoma should never be underestimated, but treating a tumor early rather than after it is allowed to progress could be lifesaving.
Leland Fay, 46, understands better than most the seriousness of this distinction. When the Monument, Colorado native was diagnosed with melanoma in 2012, he was given a bleak prognosis due to the advanced stage of the tumor it had already reached stage IV.
Leland hadnt thought much of the little black mole on his head a few months earlier, when a dermatologist froze it off during a routine exam. But the mole resurfaced, bigger than it had been originally. After a biopsy and imaging tests, doctors told Leland it was melanoma, and that it had already spread. He could have as few as six weeks to live.
To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumor site.
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How Serious Is My Cancer
If you have melanoma, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage describes the growth or spread of the melanoma through the skin. It also tells if it has spread to other parts of your body.
Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.
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.
Expert
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What Affects How Fast Melanoma Spreads
The type of melanoma makes a difference. When the cancer cells invade the deeper skin layers, known as invasive melanoma, it spreads faster, grows faster and is the most dangerous. Superficial melanomas and Lentigo maligna melanomas grow more slowly, are often easier to treat, and have a higher cure rate than invasive melanoma, when diagnosed in an early stage.
Certain genetic changes can affect how quickly this cancer spreads. Certain gene abnormalities encourage this cancer to invade surrounding tissue. People who have two copies of the cyclin variant were at an 80 percent higher risk of developing melanoma.
The composition of abnormal cells, or the grade of cancer, can result in melanoma spreading faster. When high grade cancer is present and very abnormal cells make up the tumor, this cancer most often spreads and grows very fast. Low grade cancer in which the tumor is made of cells that only slightly differ from normal cells, most often grow slowly, and in some cases, do not spread at all.
Treatments For Advanced Melanoma
In most cases, treatment can’t cure advanced melanoma. But some can help you live longer and feel better. The goal of any therapy you get will be to shrink or remove your tumor, keep the cancer from spreading further, and ease your symptoms.
Surgery. This is the main way to remove melanoma from the skin and lymph nodes. You might also have an operation on organs where the cancer has spread. Thereâs no guarantee your surgeon will get all of it. Some melanoma is too small to see, even with high-tech scans.
Radiation. Your doctor might recommend radiation to kill any cancer cells that have been left behind after surgery or if melanoma spreads to your brain or bones. It can also relieve pain from the disease or treat melanoma that comes back over and over.
Immunotherapy or biologic therapy. These drugs help your immune system find and attack cancer cells. Depending on the ones you take, you might have to go in for treatment every 2, 3, or 4 weeks.
Your doctor might want you to take more than one drug. Some studies show that people who do have fewer side effects.
The flip side of immunotherapy is that sometimes these drugs cause your immune system to attack healthy organs. Then youâd need to stop melanoma treatment and take drugs to stop the attack.
Chemo can shrink the cancer, but chances are it will start growing again after a few months and youâll need more treatment. Immunotherapy and targeted therapy usually work better.
Other side effects include:
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Prevention And Early Detection
The exact cause of subungual melanoma is unknown, meaning that patients cannot take specific steps to prevent this condition. However, because it may be associated with trauma to the hands and feet, you may want to keep yours hands and feet protected.2 For example, you can protect your hands and feet by wearing gloves during heavy labor, or wearing protective gear and sturdy shoes during sports.
Early detection is crucial to the treatment of subungual melanoma, so be sure to tell your doctor about any changes to your nails.1 You can regularly check your nails, fingers, and toes for any bruising, streaking, or changes.3
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?
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Why Choose Msk For A Skin Cancer Diagnosis
It is not always easy for doctors to tell the difference between an unusual but noncancerous mole and a melanoma. A diagnosis can sometimes be challenging to make. Memorial Sloan Kettering is one of the few hospitals in the United States with access to advanced diagnostic techniques that can help accurately evaluate a tumor.
At Memorial Sloan Kettering, sophisticated pathology and imaging tests provide our care teams with a great deal of information. The pathologists and other experts who perform these tests focus on skin cancer care and melanoma in particular. This training gives our team the expertise to ensure that you get the right diagnosis and to personalize your care as much as possible.
Who Gets Superficial Spreading Melanoma
According to New Zealand Cancer Registry data, 2256 invasive melanomas were diagnosed in 2008 48% were in males. At least 40% were reported to be superficial spreading melanoma. There were 371 deaths from all types of melanoma in 2008 .
Superficial spreading melanoma accounts for two-thirds of cases of melanoma in Australia and New Zealand. It nearly always arises in white skinned individuals. Although more common in very fair skin , it may also occur in those who tan quite easily . It is rare in brown or black skin .
Superficial spreading melanoma is equally common in males and females. Only 15% of melanomas arise before the age of 40, and it is rare under the age of 20 .
The main risk factors for superficial spreading melanoma are:
- Increasing age
- Multiple atypical naevi
- Strong family history of melanoma with 2 or more first-degree relatives affected
- Fair skin that burns easily
- History of blistering sunburn.
Less strong factors include blue or green eyes, red or blond hair, indoor occupation with outdoor recreation, and signs of sun damage.
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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.
Where Melanoma Spreads
Studies have shown that melanoma can spread to almost any area of the bodya wider variety of areas than any other cancer. The likelihood that it will spread to each organ is as follows:
- Lymph Nodes: 50% to 75%
- Lungs and area between the lungs: 70% to 87%
- Liver: 54% to 77%
- Gastrointestinal tract: 26% to 58%
- Heart: 40% to 45%
- Adrenal glands: 36% to 54%
- Kidneys: 35% to 48%
- Spleen: 30%
Metastasis in the brain usually occur late in stage IV disease and carry the worst prognosis, with an average survival of only four months.
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When To See A Doctor
âYou should see a doctor as soon as you suspect you have a subungual melanoma. More generally, visit your doctor when you see a fingernail or toenail that:
- Has dark streaks
- âHas deep grooves or gaps
- Lâooks thick and overgrown
- Looks thin and spoon-shaped
- Looks like you have been picking at or pulling back on the cuticle, the skin at the bottom of your nail
Whats The Outlook For Stage 4 Melanoma
Once the cancer spreads, locating and treating the cancerous cells becomes more and more difficult. You and your doctor can develop a plan that balances your needs. The treatment should make you comfortable, but it should also seek to remove or slow cancer growth. The expected rate for deaths related to melanoma is 10,130 people per year. The outlook for stage 4 melanoma depends on how the cancer has spread. Its usually better if the cancer has only spread to distant parts of the skin and lymph nodes instead of other organs.
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Education And Advising Clients
Despite efforts to educate the public about subungual melanoma in the last couple of decades, awareness of this type of cancer remains poor, noted the authors of a paper published in the Journal of the American Academy of Dermatology in 2018. This is why nail techs, who interact with people who might not see health care providers regularly, are a crucial piece of the detection puzzle, they wrote.
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Many Melanomas Dont Require Immediate Treatment
Many people have this concept that all melanomas are extremely rapidly growing cancers, says Dr. Marghoob. They think that waiting even one day after the diagnosis of melanoma can be fatal.
While some subtypes of melanoma do grow extremely fast, says Dr. Marghoob, most early melanomas dont require immediate treatment, allowing ample time to detect, treat, and cure them. Dr. Marghoob advises checking your skin on a monthly basis. If you notice a changing spot on your skin, dont delay in getting it checked out by a dermatologist, he says. And if your doctor does think you may have a melanoma, know that for most people its not necessary to rush to treatment. Most people can take the time they need to meet with doctors and understand their options.
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What Is The Cause Of Superficial Spreading Melanoma
Superficial spreading melanoma is due to the development of malignant pigment cells along the basal layer of the epidermis. The majority arise in previously normal-appearing skin. About 25% develop within an existing melanocytic naevus, which can be a normal common naevus, an atypical or dysplastic naevus, or a congenital naevus.
What triggers the melanocytes to become malignant is not fully known. Specific genemutations such as BRAFV600E have been detected in many superficial spreading melanomas and these mutations may change as the disease advances.
Damage by ultraviolet radiation results in a degree of immune tolerance, allowing abnormal cells to grow unchecked. This can occur from exposure to natural sunlight, particularly if sunburn has occurred, and artificial sources of ultraviolet radiation from sun beds / solaria.
Mistaken For A Bruise
Many people first mistake subungual melanoma as a bruise.3,4 However, unlike a bruise, the streaks from subungual melanoma do not heal or grow out with the nail over time.4 It can also be confused with normal pigmentation of the nail bed or a fungal infection.2 While you can have a streak or bruising under the nail that isnt melanoma, you should ask a dermatologist to check your nails if you notice any changes.
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Taking Care Of Yourself
Hearing that your cancer has spread is scary, but a lot of research is underway to find new treatments. And there are treatments available to try to stop the disease from spreading, so you can live longer.
It’s important to have support and to talk about your fears and feelings, too. Your doctor can help you find a cancer support group.
These tips may help you feel better during melanoma treatment:
- If you lose your appetite, eat small amounts of food every 2 to 3 hours instead of bigger meals. A dietitian can give you other tips on nutrition and eating during your cancer treatment. Ask your doctor for a referral.
- Exercise can help you feel better overall and fight fatigue. But listen to your body, and balance rest and activity.
- Get the kind of emotional support that’s right for you. It could be from family, friends, your cancer support group, or a religious group.
Could It Just Be A Bruise
Just for some reference, here are some images of bruises of the toe and toenail for you to compare.
The marking on this toenail is a bruise. Note the mark goes across the nail and you can see some bruising on the skin too.
This bruised toenail has a white mark where the damage was caused and the mark looks like blood.
Where there is a marking at the base of the nail like in this image, this is usually caused by impact damage kicking something for example.
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Tests That Might Be Done
Biopsy: In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is. There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.
Lab tests of biopsy samples: If melanoma is found, lab tests might be done on the cancer cells to see if they have certain gene changes. This might affect your treatment options.
Chest x-ray: This test may be done to see if the melanoma has spread to your lungs.
Ultrasound: This test uses sound waves and their echoes to make pictures of the inside of your body. Ultrasound might be used to look at lymph nodes near the tumor to see if the cancer has spread there.
CT or CAT scan: This test uses x-rays to make detailed pictures of your insides. A CT scan may be used to see if nearby lymph nodes are swollen or if organs like the lungs or liver have spots that might be from the spread of melanoma. If any spots are found, a CT scan might be used to guide a needle into the spots to do a biopsy.
MRI scan: This test uses radio waves and strong magnets instead of x-rays to make detailed pictures of your insides. It’s very good for looking at the brain and spinal cord. This test can help show if the cancer has spread.