What Is Metastatic Melanoma
Melanoma is a type of skin cancer. When it spreads to other places in your body, it’s called metastatic, or advanced. You may also hear your doctor refer to it as stage IV melanoma.
Melanoma often spreads to:
Although in many cases metastatic melanoma canât be cured, treatments and support can help you live longer and better. Doctors have therapies that have greatly increased survival rates. And researchers are working to find new medications that can do even more.
Remember: You still have control over the decisions you make about your treatment and your life. It’s important to have people you can talk to about your plans, your fears, and your feelings. So find support and learn about your treatment options. That will help you make the most of your life.
How Fast Melanoma Spreads
Some forms of melanoma can spread quickly, though the exact timeline will depend on your individual health situation. The timeline can be impacted by factors like your age, family history, any underlying medical conditions you may have, as well as what kind of melanoma you have.
During the diagnosis process, your dermatologist will determine what stage your cancer is at. The stage of your melanoma indicates what kind of treatment youll need.
Melanoma can spread quickly and be difficult to treat at later stages, so its important to seek treatment immediately after diagnosis, even if youre only at Stage 0 or Stage 1.
Protect the skin youre in.
Skincare is healthcare
What Stages Have To Do With Cancer Spread
Cancers are staged according to tumor size and how far it has spread at the time of diagnosis. Stages help doctors decide which treatments are most likely to work and give a general outlook.
There are different types of staging systems and some are specific to certain types of cancer. The following are the basic stages of cancer:
- In situ. Precancerous cells have been found, but they havent spread to surrounding tissue.
- Localized. Cancerous cells havent spread beyond where they started.
- Regional. Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant. Cancer has reached distant organs or tissues.
- Unknown. Theres not enough information to determine the stage.
- Stage 0 or CIS. Abnormal cells have been found but have not spread into surrounding tissue. This is also called precancer.
- Stages 1, 2, and 3. The diagnosis of cancer is confirmed. The numbers represent how large the primary tumor has grown and how far the cancer has spread.
- Stage 4. Cancer has metastasized to distant parts of the body.
Your pathology report may use the TNM staging system, which provides more detailed information as follows:
T: Size of primary tumor
- TX: primary tumor cant be measured
- T0: primary tumor cant be located
- T1, T2, T3, T4: describes the size of the primary tumor and how far it may have grown into surrounding tissue
N: Number of regional lymph nodes affected by cancer
M: Whether cancer has metastasized or not
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Clinical Characteristics Of The Patients With Brain Metastasis
A total of 79 patients were identified for this analysis. The demographic and baseline characteristics of the patients are described in Table . The median time from primary melanoma diagnosis to brain metastasis was 3.2 years , and the median time from stage IV diagnosis to brain metastasis was 2 months . Forty patients had prior extracranial metastasis at the time of initial brain metastasis 28 had concurrent extracranial metastasis at the time of brain metastasis and 5 patients developed extracranial metastasis subsequently, defined as at least 1 month after initial diagnosis of brain metastasis. Six patients had brain metastasis as the only site of distant metastasis until death or at the time of the analysis.
Table 1 Patient characteristics and treatment
The cerebrum was the most common site of brain metastasis , and 21.5% and 8.9% patients had metastasis to the cerebellum and pons, respectively. Thirty-nine had a solitary brain metastasis at the initial brain metastasis diagnosis, and the largest size of the initial brain metastasis was 10 mm or less in 31.7%. Thirty-six patients had neurological symptoms associated with brain metastasis. Forty-nine of the 79 patients had received systemic therapy prior to or at the time of brain metastasis, including checkpoint inhibitors, targeted drugs, cytotoxic chemotherapy and/or cytokine therapy.
When Melanoma Can’t Be Cured
If your cancer has spread and it is not possible to cure it by surgery, your doctor may still recommend treatment. In this case, treatment may help to relieve symptoms, might make you feel better and may allow you to live longer.Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled. For example, if you have pain, there are effective treatments for this. General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with cancer.
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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.
You Of Course May Not Think The Tiny Speck Is Melanoma But Over Time Its Going To Get Bigger Or Spread Superficially
How long does this take to happen, or to put it another way, how fast does this spreading or growth occur?
Melanomas can either have not spread past the skin or already be metastatic by the time you find a 1 mm lesion, says Dr. Jennifer Gordon, who is board certified by the American Board of Dermatology she practices at Westlake Dermatology located in Austin, Texas.
Dr. Gordon points out, however: A 1 mm lesion would be rare to be already metastatic.
This would be the nodular type of melanoma, which is an uncommon sub-type of this skin malignancy.
I realize this offers little comfort, but it is the unfortunate truth, continues Dr. Gordon. There are multiple types of melanomas, such as:
- Melanoma in-situ
- Nodular melanoma
- Desmoplastic melanoma, etc.
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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.
Recognize Your Feelings And Concerns
Talking about fears and concerns is important, even when treatment is working well. Tell your health care team about emotional symptoms. People may live for years with metastatic cancer. Your doctor can help you have the best quality of life possible during this time. Hospitals and medical centers have many resources for you and your family.
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Predictive Factors For Overall Survival
We analyzed the potential association between several factors and survival using univariate Cox regression of overall survival . Intriguingly, of factors in the primary tumor, increased levels of tumor-infiltrating lymphocytes showed a trend toward improved survival in patients with brain metastasis. Several clinical factors were found to be significantly associated with overall survival in patients with brain metastasis by univariate analysis . Factors associated with shorter overall survival included male sex, cerebellar involvement, higher number of metastatic brain tumors, concurrent presence of adrenal metastasis, or treatment with whole-brain radiation therapy. Factors associated with longer overall survival were treatment with craniotomy, stereotactic radiosurgery, or anti-PD-1 antibody therapy after initial diagnosis of brain metastasis.
Table 4 Univariate Cox regression analysis of association of various clinical factors with overall survival in melanoma patients with brain metastasis
Multivariate analysis of all eight factors revealed cerebellar involvement, craniotomy, and adrenal involvement as independently predictive of survival . There was trend toward significance for treatment with anti-PD-1 antibody .
Table 5 Multivariate Cox regression analysis of association of various clinical factors with overall survival in melanoma patients with brain metastasis
Skin Cancer Undiagnosed For Over 10 Years
The patient had neglected his illness for more than 10 years, says a case report in the International Open Access Journal of the American Society of Plastic Surgeons .
The patient was a man, 48, living in a U.S. city. The medical attention was sought out due to the insistence of a family member, continues the paper.
The cancer was basal cell carcinoma that had grown to 10 centimeters on his scalp. Somehow this patient didnt mind living with an ulcerating, oozing and bleeding growth on his head.
Had he not sought treatment, he could have lived many more years barring death from an unrelated cause such as a heart attack or car accident.
With that all said, there is no data on what the record is for how long a person lived with an undiagnosed skin cancer.
Certainly you can imagine there must be many cases of people all over the world, living in undeveloped societies with scant medical care, let alone skin cancer awareness, whove been living for over 20 years with a slowly growing bump or patch.
This would describe basal cell carcinoma.
But a person will not get away for too long with an undiagnosed melanoma, as it WILL spread and cause symptoms of that spread, such as respiratory problems or ongoing severe headaches .
Dr. Musick says that the following are common ways that skin cancer shows up:
red bump that bleeds easily a scab or wound that just wont heal slowly enlarging pink or red patch of skin a dark irregularly-bordered bump or spot
Steven Musick, MD
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Temporal And Spatial Complexity Of Metastasis
Metastasis involves a series of steps which must be completed before the emergence of clinically meaningful metastatic disease . These steps are further complicated by additional observations from human melanoma patients which add temporal and spatial complexity to metastasis. Many melanoma patients are cured after excision of their primary tumor however, some are not, and will have disease recurrence. Melanoma recurs less frequently at the site of the original primary tumor, instead more commonly recurring at different sites in the body as metastatic lesions. These recurrence patterns suggest that melanoma cells had already spread before excision of the primary tumor, even though this spread might not have been clinically apparent at that time. In melanoma patients, metastatic recurrence can occur within a relatively short period of time, but takes > 5 years in about 40% of patients., , , The period in between initial excision of the primary tumor and subsequent metastatic recurrence is often referred to as metastatic dormancy, where previously disseminated tumor cells are thought to persist in a relatively non-proliferative state.
What Do Stage 4 Tumors Look Like
A change to an existing mole or normal skin can be the first sign that the cancer has spread. But the physical symptoms of stage 4 melanoma arent the same for everyone. A doctor will diagnose stage 4 melanoma by looking at the primary tumor, the spread to nearby lymph nodes, and whether the tumor has spread to different organs. While your doctor wont base their diagnosis only on what your tumor looks like, part of their diagnosis involves looking at the primary tumor.
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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.
What Is The Outlook For Patients With Metastatic Melanoma
In most instances, it is not possible to cure metastatic melanoma entirely because it tends to spread to multiple sites. Treatment is focussed on improving the quality of life and the length of survival.
The prognosis of melanoma depends on the disease staging, which is based around characteristics of the primary tumour, nodal and distant metastases. The prognosis is poorer with higher numbers of involved nodes and with metastases to internal organs and distant sites.
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Why Are Brain Metastases So Difficult To Treat
There are several potential reasons:
- There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently.
- The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in.
- Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one.
- Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms.
- The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain.
- Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.
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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Diagnosing Metastatic Pancreatic Cancer
There are quite a few tests that can be used to determine the cause of a persons symptoms. Usually, this involves one or more imaging scans or tissue tests.
With regard to imaging, CT scans and MRIs are often used to confirm a pancreatic cancer diagnosis. However, if an oncologist suspects that cancer has spread to other parts of the body, a PET scan may be recommended as well. PET scans can detect abnormal chemical reactions within the body, which can help an oncologist identify a small metastasis very early on.
At Moffitt Cancer Center, we use the most advanced and reliable diagnostic tests for pancreatic cancer. We also offer comprehensive, individualized treatment, using each patients unique diagnosis to make evidence-based recommendations.
The majority of pancreatic cancer patients present with advanced disease. Patients start developing symptoms related to site where the tumor has spread. When cancer spreads to the liver or the peritoneum patients can experience abdominal pain, abdominal swelling and abnormal liver enzymes. Symptoms related to metastatic cancer include fatigue, unintentional weight loss, abdominal pain, back pain, jaundice and decline in fitness.