Risk Factors For Metastatic Melanomas
You cannot get metastatic melanoma without first having melanoma, though the primary melanoma may be so small its undetectable. Major risk factors for melanomas include:
- Light skin, light-colored hair or light-colored eyes
- Skin prone to burning easily
- Multiple blistering sunburns as a child
- Family history of melanoma
- Frequent exposure to sun or ultraviolet radiation
- Certain genetic mutations
- Exposure to environmental factors, such as radiation or vinyl chloride
Other factors have been connected with increased metastasis. In a 2018 study in the Anais Brasileiros de Dermatologia and a 2019 study in the Journal of the National Cancer Institute, the following factors were associated with higher levels of metastasis:
- Male gender
- Primary tumor thickness of more than 4 mm
- Nodular melanoma, which is a specific subtype that a care team would identify
- Ulceration of the primary tumor
What Do Patients Say
Pam Smith, 67, from Royal Tunbridge Wells, started on the trial in January 2014.
She was “devastated” when she was told her cancer was untreatable and says she “wouldn’t have stood a chance” without immunotherapy.
She had treatment once every two weeks for four months, but the drugs gave her such severe diarrhoea as a side-effect that she could no longer continue.
Her tumour halved in size after treatment and has not grown since. Pam now feels “brilliant”.
She told the BBC: “I might not have seen my grandchildren.
“It’s just over five years now since it happened and my youngest grandchild was six at the weekend.
“I wouldn’t have seem him grow up and the other grandchildren as well.”
How Can You Manage Stage 3 Melanoma
Managing stage 3 melanoma can be challenging. With technological and medical advances, this diagnosis may not be as severe as it once was.
After your surgery or if youre unable to undergo surgery, you may need adjuvant treatment to prevent the cancer from coming back. There is adjuvant radiation therapy and adjuvant immunotherapy. These therapies help reduce the risk of melanoma returning, but they dont increase your survival rate.
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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.
Complementary And Alternative Treatments
It’s common for people with cancer to seek out complementary or alternative treatments. When used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life. Others may not be so helpful and in some cases may be harmful.
It is important to tell all your healthcare professionals about any complementary medicines you are taking. Never stop taking your conventional treatment without consulting your doctor first.
All treatments can have side effects. These days, new treatments are available that can help to make many side effects much less severe than they were in the past.
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Common Places For Melanoma To Spread
Melanoma can spread from the original site on your skin and form a tumor in any organ or body tissue, but its most likely to metastasize to the lymph nodes, liver, brain, lungs, and less commonly, the bones. Melanoma really likes the brain and the liver, says Lisa Zaba, M.D., dermatologic oncologist at Stanford Medical Center in San Jose, CA. If you notice any of the following red flags, it might mean your melanoma has spread and warrants a call to your doctor right away.
Treatments For Metastatic Melanoma Skin Cancer
The following are treatment options for metastatic melanoma skin cancer. Metastatic melanoma skin cancer means that the cancer has spread to or come back in other parts of the body farther from where it started. This includes stage 4 and distant recurrences. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Find out more about .
The following treatment options may also be used for locoregional melanoma skin cancer that cannot be removed by surgery.
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What Are The Survival Rates For Melanoma
Melanoma can be treated most effectively in its early stages when it is still confined to the top layer of the skin . The deeper a melanoma penetrates into the lower layers of the skin , the greater the risk that it could or has spread to nearby lymph nodes or other organs. In recent years, clinical breakthroughs have led to new treatments that continue to improve the prognosis for people with advanced melanoma.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for melanoma skin cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread beyond the skin where it started.
- Regional: The cancer has spread beyond the skin where it started to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body, such as the lungs, liver, or skin on other parts of the body.
Not Long Ago Little To Offer
Chapman remembers a time, not so long ago, when medicine had little to offer these patients. He remembers hearing colleagues saying that “melanoma is what gives cancer a bad name!”
However, Chapman pointed out that melanoma wasn’t really that much worse than other cancers during that time period many other tumor types also had few therapeutic options.
“But still, prognosis was pretty poor,” he said.
“In those days, we had a few treatments for melanoma, and sometimes they worked and mostly they didn’t,” he said. “Once in a while we had a patient who had a clear benefit, and occasional cures, but they were rare.”
Until 2011, there were only two therapies that were approved for metastatic melanoma: chemotherapy with dacarbazine and immunotherapy with high-dose interleukin 2 , and neither one was very effective at prolonging life, he noted.
Chemotherapy was once the standard of care but now it is typically used as third-line therapy, Chapman explained. “It’s just not used that often anymore, and the more junior doctors don’t even know the doses.”
Dacarbazine was the first systemic drug approved for metastatic melanoma in 1975 but was also the last chemotherapeutic agent to receive approval for this indication.
“Dacarbazine had a 5%-20% response rate and no overall survival benefit,” said Friedlander. “Subsequent studies of combinations of chemotherapy also didn’t show any survival benefit and that was very disappointing.”
Survival Rates For Merkel Cell Carcinoma
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with your situation ask how these numbers may apply to you.
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Helping Patients With Scanxiety
The stress that often accompanies the routine imaging scans that patients undergo to monitor changes in their health is sometimes called scanxiety.
Scanxiety is a real phenomenon, said Dr. Temel. Its natural to feel anxious when youre waiting for an important test result, and I dont think theres a quick fix to it.
Providing patients with information they can understand about their diagnosis and treatment is one way that Dr. Temel tries to support her patients and lessen their stress. We know that when patients have accurate information, they are better prepared and make more appropriate decisions about the future, she said.
She also conveys a message to her patients and families: Were going to be here for you whether the scan result is good news or bad news, and we have a plan for the future.
This reassurance may make the period of anxiety and worry slightly less distressing, Dr. Temel said. Then she added, I hate waiting for test results, too. Its part of being human.
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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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
Is Immunotherapy Right For Me
These drugs donât work for everyone with melanoma. Scientists are hard at work to figure out why and pinpoint the differences between patients who respond and those who donât.
One reason why they may work better for some people than others: Doctors think tumors that have the most DNA damage are more likely to respond to these drugs. This makes sense: The mutant molecules stick out on the surface of the tumor cell, making it easier for the immune system to recognize them as foreign.
This means the drugs may work best with melanomas caused by too much DNA-damaging UV radiation. These findings could lead to diagnostic tests that identify which patients are most likely to benefit from these therapies.
Then again, there isnât a direct cause and effect at play. Generally, the more mutations you have, the better your response will be. But not always. Some people donât have a lot of genetic mutations but respond well. Scientists believe that other — and as yet undiscovered — checkpoints may be the cause.
Or your immune system may need a little more help spotting cancer cells so it can destroy them. Pairing these immune-based anti-cancer drugs, like a mix of ipilimumab and pembrolizumab, might work better. Studies showed a good response rate, and doctors got the FDAâs OK to use the combo in 2015.
American Cancer Society: âImmune checkpoint inhibitors to treat cancer,â âIf You Have Melanoma Skin Cancer,â âImmunotherapy for melanoma skin cancer.â
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What Else Should I Know About Treatment For Advanced Melanoma
Thanks to research breakthroughs, more patients diagnosed with advanced melanoma are living longer some for years.
Because these breakthrough are relatively recent, its important to:
Work with a team of melanoma specialists.
Ask your melanoma specialists if any of the newer treatments are appropriate for you.
Realize that no one treatment works for everyone, so you may need to try different treatments or combine treatments.
Researchers continue to study advanced melanoma, and next-generation treatments are now being studied in clinical trials. If you want to know whether you are a match for a trial, you can find out if there are any relevant trials at, Clinical Trial Finder.
Related AAD resources
ReferencesChukwueke U, Batchelor T, et al. Management of brain metastases in patients with melanoma. J Oncol Pract. 2016 12:536-42.
Emory Medical Center. A year in the life: Jimmy Carter shares his cancer experience. Posted July 11, 2016. Last accessed March 26, 2018.
Podlipnik S, Carrera C, et al. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. J Am Acad Dermatol. 2016 75:516-24.
Nordmann N, Hubbard M, et al. Effect of gamma knife radiosurgery and programmed cell death 1 receptor antagonists on metastatic melanoma. Cureus. 2017 9: e1943.
Our Studyand The Implications Of Our Findings
We conducted a retrospective study of 425 patients with 2,488 melanoma brain metastases diagnosed and managed with multimodality treatment at MSK between 2010 and 2019. Median OS was 8.9 months. However, patients diagnosed between 2015 and 2019 experienced a significantly longer OS of 13 months, compared with only 7 months for those diagnosed between 2010 and 2014 . The one-year survival rate was 52.4 percent for patients diagnosed in the latter five years, compared with 35.1% for those diagnosed in the earlier five years , with a median follow-up of 1.7 years for survivors in the latter group.1
Our empirically derived cutoff for the most significant increase in survival between 2014 and 2015 coincided with the US Food and Drug Administrations approval of PD-1 blockade with nivolumab and pembrolizumab, and the subsequent approvals of the combinations ipilimumab plus nivolumab, dabrafenib plus trametinib, and vemurafenib plus cobimetinib.1
Nelson Moss, MD, neurosurgeon, coheads the Multidisciplinary Brain Metastasis Clinic at MSK
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What Do Experts Think
Prof Charles Swanton, chief clinician at Cancer Research UK, said the progress in melanoma had been “incredibly fast”.
He said: “I’m inspired seeing the advancements being made in the development of immunotherapies, and their potential to transform the outlook for some patients, giving them time with friends and family they never thought they would have.
“And now work continues to make sure more people with different types of cancer can also benefit from these innovative treatments.”
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.
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How Does Immunotherapy Work
Ipilimumab and nivolumab both stop some cancers from hiding and allow the immune system to attack.
They interrupt the chemical signals that cancers use to put the brakes on the immune system.
Nivolumab blocks the off-switch on white blood cells called PD-1. Ipilimumab blocks a similar switch called CTLA-4.
It is described as taking the brakes off the immune system.
“By giving these drugs together you are effectively taking two brakes off the immune system rather than one so that the immune system is able to recognise tumours it wasn’t previously recognising and react to that and destroy them,” Prof Larkin said.
Metastatic Melanoma Life Expectancy
The 5-year survival rate for a metastatic melanoma is about 15% to 20% 7). The 10-year survival is about 10% to 15% 8). The outlook is better if the spread is only to distant parts of the skin or distant lymph nodes rather than to other organs, and if the blood level of lactate dehydrogenase is normal.
- The survival differences among M categories will be useful for clinical trial stratification however, the overall prognosis of all patients with stage IV melanoma remains poor, even among patients with M1a. For this reason, the Melanoma Staging Committee recommended no stage groupings for stage IV.
Table 2. American Joint Committee on Cancer TNM system for Stage 4 Melanoma
- A sore that doesnt heal
- Spread of pigment from the border of a spot into surrounding skin
- Redness or a new swelling beyond the border of the mole
- Change in sensation, such as itchiness, tenderness, or pain
- Change in the surface of a mole scaliness, oozing, bleeding, or the appearance of a lump or bump
Be sure to show your doctor any areas that concern you and ask your doctor to look at areas that may be hard for you to see. Its sometimes hard to tell the difference between melanoma and an ordinary mole, even for doctors, so its important to show your doctor any mole that you are unsure of.
Metastatic melanoma in the brain
Figure 2. Metastatic melanoma in the brain
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