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How To Tell If Melanoma Has Spread

Red Flag #: Chest Pain And Trouble Breathing

How do you determine if the melanoma has spread?

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.

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.

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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Symptoms Of Metastatic Cancer

Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:

  • pain and fractures, when cancer has spread to the bone
  • headache, seizures, or dizziness, when cancer has spread to the brain
  • shortness of breath, when cancer has spread to the lung
  • jaundice or swelling in the belly, when cancer has spread to the liver

Symptoms If Cancer Has Spread To The Bone

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

  • pain from breakdown of the bone the pain is continuous and people often describe it as gnawing
  • backache, which gets worse despite resting
  • weaker bones they can break more easily
  • raised blood calcium , which can cause dehydration, confusion, sickness, tummy pain and constipation
  • low levels of blood cells blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding

Cancer in the spinal bones can cause pressure on the spinal cord. If it isn’t treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control . This is called spinal cord compression. It is an emergency so if you have these symptoms, you need to contact your cancer specialist straight away or go to the accident and emergency department.

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How Is Melanoma Treated

Your melanoma treatment will depend on the stage of the melanoma and your general health.

Surgery is usually the main treatment for melanoma. The procedure involves cutting out the cancer and some of the normal skin surrounding it. The amount of healthy skin removed will depend on the size and location of the skin cancer. Typically, surgical excision of melanoma can be performed under local anesthesia in the dermatologist’s office. More advanced cases may require other types of treatment in addition to or instead of surgery.

Treatments for melanoma:

  • Melanoma Surgery: In the early stages, surgery has a high probability of being able to cure your melanoma. Usually performed in an office, a dermatologist numbs the skin with a local anesthetic and removes the melanoma and margins .
  • Lymphadenectomy: In cases where melanoma has spread, removal of the lymph nodes near the primary diagnosis site may be required. This can prevent the spread to other areas of your body.
  • Metastasectomy: Metastasectomy is used to remove small melanoma bits from organs.
  • Targeted cancer therapy: In this treatment option, drugs are used to attack specific cancer cells. This targeted approach goes after cancer cells, leaving healthy cells untouched.
  • Radiation Therapy: Radiation therapy includes treatments with high-energy rays to attack cancer cells and shrink tumors.
  • Immunotherapy: immunotherapy stimulates your own immune system to help fight the cancer.

Medical History And Physical Exam

Usually the first step your doctor takes is to ask about your symptoms, such as when the mark on the skin first appeared, if it has changed in size or appearance, and if it has been painful, itchy, or bleeding. You may also be asked about your possible risk factors for melanoma skin cancer, such as your history of tanning and sunburns, and if you or anyone in your family has had melanoma or other skin cancers.

During the physical exam, your doctor will note the size, shape, color, and texture of the area in question, and whether it is bleeding, oozing, or crusting. The rest of your body may be checked for moles and other spots that could be related to skin cancer .

The doctor may also feel the lymph nodes under the skin in the neck, underarm, or groin near the abnormal area. When melanoma spreads, it often goes to nearby lymph nodes first, making them larger.

If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, a doctor who specializes in skin diseases, who will look at the area more closely.

Along with a standard physical exam, many dermatologists use a technique called dermoscopy to see spots on the skin more clearly. The doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is used with this instrument. The doctor may take a digital photo of the spot.

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What Is Metastatic Cancer

In metastasis, cancer cells break away from where they first formed , travel through the blood or lymph system, and form new tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.

Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.

When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.

Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.

Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.

Red Flag #: Swollen Lymph Nodes

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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.

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What About Other Treatments I Hear About

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.

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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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.

Stop Tumors In Their Tracks

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Every melanoma has the potential to become deadly, but the difference between an in situ melanoma and one that has begun to metastasize cannot be overstated. There is a drastic change in the survival rate for the various stages of tumors, highlighting the importance of detecting and treating melanomas before they have a chance to progress. Its impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.

To be sure youre spotting any potential skin cancers early, The Skin Cancer Foundation recommends monthly skin checks, and scheduling an annual total-body skin-exam with a dermatologist. These skin exams can help you take note of any new or changing lesions that have the potential to be cancerous, and have them biopsied and taken care of before they can escalate.

Trust your instincts and dont take no for an answer, Leland says. Insist that a doctor biopsy anything you believe is suspicious.

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What Happens When Melanoma Spreads

As soon as cancer cells get into a lymph vessel near your melanoma, it means your cancer has started to spread. Affected lymph nodes usually swell. Your doctor will check for near your melanoma. Lymph nodes are usually painless, but they may be painful if they are pressing on a nerve.

If cancer cells block lymph flow, fluid can leak out of lymph vessels and cause swelling. The medical term for this is lymphedema. The spread of cancer can cause lymphedema. So can some cancer treatments, like surgery and X-ray treatment. Lymphedema can affect any part of your body. It’s most obvious when it develops in your legs or arms.

Symptoms may include:

  • Trouble moving

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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Surgical Lymph Node Biopsy

This procedure can be used to remove an enlarged lymph node through a small incision in the skin. A local anesthetic is generally used if the lymph node is just under the skin, but the person may need to be sedated or even asleep if the lymph node is deeper in the body.

This type of biopsy is often done if a lymph nodes size suggests the melanoma has spread there but an FNA biopsy of the node wasnt done or didnt find any melanoma cells.

How Fast Does Melanoma Spread

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Melanoma is a deadly form of skin cancer because of its ability to metastasize to local lymph nodes and other organs. It is estimated that melanoma kills, on average, over 10,000 people in the United States every year.

The first sign of flat melanoma is usually a new spot or an existing mole or freckle that changes in appearance. Some changes can include:

  • A spot that has grown in size
  • A spot where the edges are looking irregular versus smooth and even
  • A spot that has a range of colors such as brown, black, blue, red, white or light gray.
  • A spot that has become itchy or is bleeding

According to Dr. Andrew Duncanson, board-certified dermatologist at Forefront Dermatology, It is important to know that melanoma can appear on areas of the skin not normally exposed to the sun such as under the arm, chest, and buttocks. It can also appear in areas that you are not able to see easily on your own including the ears, scalp, back of legs, and bottom of feet. I always recommend to my patients to look for the ugly duckling spot the new spot that doesnt look like any others. Additionally, ask a family member to look over the hard to see areas monthly, while also getting an annual skin cancer exam by a board-certified dermatologist to detect skin cancer early.

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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.

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.

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