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Is Melanoma Curable In Stage 4

Unusual Moles Exposure To Sunlight And Health History Can Affect The Risk Of Melanoma

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Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for melanoma include the following:

  • Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly.
  • Blue or green or other light-colored eyes.
  • Red or blond hair.
  • Being exposed to natural sunlight or artificial sunlight .
  • Being exposed to certain factors in the environment . Some of the environmental risk factors for melanoma are radiation, solvents, vinyl chloride, and PCBs.
  • Having a history of many blistering sunburns, especially as a child or teenager.
  • Having several large or many small moles.
  • Having a family history of unusual moles .
  • Having a family or personal history of melanoma.
  • Being White.
  • Having a weakened immune system.
  • Having certain changes in the genes that are linked to melanoma.
  • Being White or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.

    See the following PDQ summaries for more information on risk factors for melanoma:

    What Treatment Options Are Available For Stage Iv Cancer

    Treatment for stage IV depends on the location of the cancer and the organs involved. The more widely the cancer has spread from the site where it was first diagnosed, the more difficult it becomes to treat. Patients diagnosed with stage IV or metastatic cancer may not survive long without treatment.

    Options to treat stage IV cancer may involve chemotherapy, radiation therapy, biological therapy, hormone therapy or surgery, or a combination of these modalities.

    While chemotherapy can often kill a small number of cancer cells, it is usually less effective in eradicating a larger number of tumor cells present in widespread metastases. If the cancer has spread to only a few small areas, surgeons may be able to remove it to prolong the patients survival.

    In most cases, treatment of stage IV cancer is aimed at prolonging patients survival and improving their quality of life.

    Certain Factors Affect Prognosis And Treatment Options

    The prognosis and treatment options depend on the following:

    • The thickness of the tumor and where it is in the body.
    • How quickly the cancer cells are dividing.
    • Whether there was bleeding or ulceration of the tumor.
    • How much cancer is in the lymph nodes.
    • The number of places cancer has spread to in the body.
    • The level of lactate dehydrogenase in the blood.
    • Whether the cancer has certain mutations in a gene called BRAF.
    • The patients age and general health.

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    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.

    Stage I And Stage Ii Melanoma

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    Stage I and stage II melanoma describe invasive cancer that has grown below the epidermis to the next layer of skin, the dermis. It has not reached the lymph nodes.

    Two major factors help determine the seriousness of stage I melanoma and stage II melanoma: Breslow depth and ulceration.

    Breslow depth is a measurement that doctors use to describe the depth of an invasive melanoma in millimeters. It measures how far melanoma cells have reached below the surface of the skin. The thinner the melanoma, the better the chances for a cure.

    Ulceration means that there is broken skin covering the melanoma. This breakage can be so small that it can only be seen under a microscope. Ulceration is an important factor in staging. A melanoma with ulceration may require more aggressive treatment than a melanoma of the same size without ulceration.

    Melanoma is considered stage 1A when:

    • the tumor is less than or equal to 1 millimeter thick in Breslow depth

    Melanoma is considered stage IB when:

    • the tumor is 1.1 to 2 millimeters thick in Breslow depth without ulceration

    Melanoma is considered stage IIA when:

    • the tumor is 1.1 to 2 millimeters thick in Breslow depth with ulceration
    • the tumor is 2.1 to 4 millimeters thick in Breslow depth without ulceration

    Melanoma is considered stage IIB when:

    • the tumor is 2.1 to 4 millimeters thick in Breslow depth with ulceration
    • the tumor is more than 4 millimeters in Breslow depth without ulceration

    Melanoma is considered stage IIC when:

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    Patients May Want To Think About Taking Part In A Clinical Trial

    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

    Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

    Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

    Treating Stage Ii Melanoma

    Wide excision is the standard treatment for stage II melanoma. The width of the margin depends on the thickness and location of the melanoma.

    Because the melanoma may have spread to nearby lymph nodes, many doctors recommend a sentinel lymph node biopsy as well. This is an option that you and your doctor should discuss.

    If an SLNB is done and does not find cancer cells in the lymph nodes, then no further treatment is needed, although close follow-up is still important.

    If the SLNB finds that the sentinel node contains cancer cells, then a lymph node dissection will probably be done at a later date. Another option might be to watch the lymph nodes closely by getting an ultrasound of the nodes every few months.

    If the SLNB found cancer, adjuvant treatment with an immune checkpoint inhibitor or targeted therapy drugs might be recommended to try to lower the chance the melanoma will come back. Other drugs or perhaps vaccines might also be options as part of a clinical trial.

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    Recurrence In Other Parts Of The Body

    Melanoma can also come back in distant parts of the body. Almost any organ can be affected. Most often, the melanoma will come back in the lungs, bones, liver, or brain. Treatment for these recurrences is generally the same as for stage IV melanoma . Melanomas that recur on an arm or leg may be treated with isolated limb perfusion/infusion chemotherapy.

    Melanoma that comes back in the brain can be hard to treat. Single tumors can sometimes be removed by surgery. Radiation therapy to the brain may help as well. Systemic treatments might also be tried.

    As with other stages of melanoma, people with recurrent melanoma may want to think about taking part in a clinical trial.

    The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options.

    The 5 Stages Of Nail Melanoma

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    Nail melanoma is a life-threatening skin cancer that grows to affect the nails, usually the big toe and thumb. This disease can prove to be very deadly, however treatments are readily available if diagnosed early.

    This disease is often referred to as, Malignant Melanoma of Nail Unit or Nail Unit Melanoma.

    • The pigment producing cells of the body, called Melanocytes, is where the Melanoma cancer develops. The Melanocytes are responsible for giving our skin its color.
    • The development of Melanoma cancer, usually begins from a finger or toenail, however thats not always the case.
    • It has the tendency to affect the areas around such as the sides of nail or the nail bed. In fact, it may also spread to other parts of the body, if not treated on time.
    • The big toe or thumb is usually the first to get affected, however it may vary according to each case.
    • The Nail Unit Melanoma is divided into 3 main types:
  • Subungual Melanoma
    • Nail Melanoma is most common in light/fair skinned people as opposed to dark skinned people.

    There are 5 stages of Nail Melanoma, stated as follows

    Stage 1: aka Stage O Melanoma

    This stage is also referred to as Melanoma in situ, meaning site of origination of Melanoma. At this point, a tumor has formed on the outermost layer of the skin, epidermis.

    Stage 2: aka Stage I Melanoma

    This stage is further categorized into two:

    Stage IA: At this stage, the tumor is less than a mm deep and has no signs of an ulcer.

    Stage 3: aka Stage II Melanoma

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    What Is Stage Iii And Stage Iv Melanoma

    Stage III and Stage IV melanoma is also sometimes called advanced melanoma, or secondary melanoma. This is when the melanoma has grown beyond the skin and has either spread to your lymphatic system that is, melanoma cells can be found in your lymph nodes or has spread beyond the regional lymph nodes to other parts of your body .

    When the cancer spreads or metastasises to other parts of the body, away from the original site, the cells still have the characteristics of a melanoma even though they may now be growing somewhere else. The most common sites of melanoma metastases are in vital organs , bone, soft tissues and distant lymph nodes .

    It May Not Be Your First Run

    Many people with stage 4 melanoma have a history of primary melanoma, says Philip Friedlander, M.D., a medical oncologist specializing in melanoma at Mount Sinai Hospital in New York City. Earlier-stage melanoma that was considered high risk may return at some point as stage 4, he says. In fact, 13.4% of those with a high-risk melanoma had a recurrence, research in JAMA Dermatology showed. Seventy percent of those recurred in a local area, while 29% had a recurrence somewhere else on their body.

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    How Immunotherapy Comes Into Play

    Immunotherapy helps your natural immune system to attack cancer cells.

    One group of immunotherapy drugs in particular has shown great promise for treating advanced-stage melanoma. These drugs are known as checkpoint inhibitors. They help the immune systems T cells recognize and attack melanoma cells.

    Studies have found these medications improve survival rates for people with advanced-stage melanoma, report the authors of a review article in the American Journal of Clinical Dermatology. Research published in The Oncologist has also found that people with melanoma can potentially benefit from treatment with these drugs, regardless of their age.

    But immunotherapy doesnt work for everyone. According to a research letter published in the journal Nature Medicine, only a portion of people with melanoma benefit from treatment with checkpoint inhibitors. More research is needed to learn which people are most likely to respond well to this treatment.

    What Does This All Mean

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    Thus, a Level IV melanoma means a melanoma tha has invaded through a few of the skin layers, but if it is less than 1mm thick, it is only considered to be Stage I disease. But a Stage IV melanoma means the melanoma has spread throughout the body, and usually has very poor prognosis. Do not confuse the Level and Stage, as these have very different meanings: a Level IV melanoma has a very different management and outcome compared to a Stage IV melanoma.

    Speak to your doctor or surgeon if you are unclear. Be direct and ask the hard questions if you are unsure as to what your melanoma means and what your prognosis is in the long term. It often helps to have a relative or friend with you during the consultatiion as it is often quite easy to be overwhelmed with both emotion and information.

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    The Place For Stage 4 Alternative Cancer Treatments

    Alternative Stage 4 Cancer Treatment at Oasis of Hope Dr. Francisco Contreras

    Oasis of Hope employs different cancer treatment modalities for its stage 4 cancer treatment patients.

    A cancer is said to be in stage 4 of cancer when it has spread far away from the origin into other organs of the body, this progression is also known as metastasis and unless a metastasis is singularmeaning that it has only spread in to one specific locationand its still accessible, it usually means that the cancer will no longer be curable with localized therapies such as surgery or radiotherapy.

    At Oasis of Hope we employ specialized stage 4 cancer treatments for patients going through metastasis. The Contreras Alternative Cancer Treatment protocol has treated stage 4 cancer patients for decades and continues being on average three times more effective than traditional cancer treatments. Learn more about our stage 4 cancer survival rates and life expectancy here.

    What Is Metastatic Melanoma

    Melanoma is a cancer that begins in the melanocytes . Metastatic melanoma is considered to be a late form of stage IV of melanoma cancer and occurs when cancerous melanoma cells in the epidermis metastasize and progress to other organs of the body that are located far from the original site to internal organs, most often the lung, followed in descending order of frequency by the liver, brain, bone and gastrointestinal tract 1). The two main factors in determining how advanced the melanoma is into Stage IV are the site of the distant metastases and whether or not the serum lactate dehydrogenase level is elevated. LDH , an enzyme found in your blood and almost every other cell of your body, turns sugar into energy, and the more you have in your blood or other body fluid, the more damage has been done to your bodys tissues.

    It is crucial to diagnose melanoma in its early stages before it metastasizes, as once it has spread, it is difficult to locate its origin and so treatment and patients survival rate tends to be hindered 2).

    An estimated 178,560 cases of melanoma will be diagnosed in the U.S. in 2018 3). Of those, 87,290 cases will be in situ , confined to the epidermis , and 91,270 cases will be invasive, penetrating the epidermis into the skins second layer 4).

    Melanomas can develop anywhere on the skin, but they are more likely to start on the trunk in men and on the legs in women. The neck and face are other common sites.

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    There Are Different Types Of Treatment For Patients With Melanoma

    Different types of treatment are available for patients withmelanoma. Some treatments arestandard , and some are being tested inclinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

    Characteristics Of Stage Iii Melanoma

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    Stage III melanoma is defined by four characteristics:

  • Primary tumor depth and ulceration
  • Number of lymph nodes to which it has spread
  • Whether the tumor spread to the lymph node is clinically occult or clinically apparent
  • Clinically occult tumors are so tiny they are not visible to the naked eye. They can be detected only by microscopic evaluation after sentinel lymph node biopsy or elective lymph node dissection
  • Clinically detected tumors can be felt during physical examination or seen with the naked eye when inspected by a surgeon or pathologist. They can also be detected by imaging like CT scans and ultrasound. Their presence is confirmed by lymph node dissection or when the tumor is seen to extend beyond the lymph node capsule.
  • Presence of tumor deposits outside of the primary tumor including in-transit, satellite, or microsatellite metastases
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    Treating Stage Iii Melanoma

    These cancers have already reached the lymph nodes when the melanoma is first diagnosed. Surgical treatment for stage III melanoma usually requires wide excision of the primary tumor as in earlier stages, along with lymph node dissection.

    After surgery, adjuvant treatment with an immune checkpoint inhibitor or with targeted therapy drugs may help lower the risk of the melanoma coming back. Other drugs or perhaps vaccines may also be recommended as part of a clinical trial to try to reduce the chance the melanoma will come back. Another option is to give radiation therapy to the areas where the lymph nodes were removed, especially if many of the nodes contain cancer.

    If melanoma tumors are found in nearby lymph vessels in or just under the skin , they should all be removed, if possible. Other options include injections of the T-VEC vaccine , Bacille Calmette-Guerin vaccine, or interleukin-2 directly into the melanoma radiation therapy or applying imiquimod cream. For melanomas on an arm or leg, another option might be isolated limb perfusion or isolated limb infusion . Other possible treatments might include targeted therapy , immunotherapy, or chemotherapy.

    Some people with stage III melanoma might not be cured with current treatments, so they may want to think about taking part in a clinical trial of newer treatments.


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