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What Happens When Melanoma Spreads To The Lungs

Risk Of Further Melanomas

Metastasis: How Cancer Spreads

Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups.

Your doctor will decide how often you will need check-ups everyone is different. They will become less frequent if you have no further problems.

After treatment for melanoma it is important to limit exposure to the sun’s UV radiation. A combination of sun protection measures should be used during sun protection times .

As biological family members usually share similar traits, your family members may also have an increased risk of developing melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using a combination of sun protection measures during sun protection times.

It is important to monitor your skin regularly and if you notice any changes in your skin, or enlarged lymph glands near to where you had the cancer, see your specialist as soon as possible.

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.

Red Flag #: Unexplained Weight Loss And Loss Of Appetite

Unintentional weight loss is a common side effect of any cancer. When it comes to melanoma, extreme weight loss usually only happens after the cancer has spread from the skin to other parts of the body. Dr. Zaba says she can sometimes tell if a patients melanoma has metastasized because it looks like they have cachexia, a syndrome marked by drastic loss of fat and muscle and increased weakness. Cachexia can also cause loss of appetite, which further contributes to the problem.

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Signs Melanoma Has Spread

    Melanoma is the most dangerous type of because it spreads so quickly and so easily. That’s why it’s important to catch melanoma early. After it starts to spread, melanoma is harder to treat.

    Melanoma can spread in three ways: directly through your skin, by getting into your bloodstream, and by getting into your lymphatic systempart of your immune system.

    Melanoma can spread to almost any part of the body. It usually spreads on your skin, under your skin, or into your lymph nodes. If melanoma gets into your lymphatic system or your bloodstream, it can also spread to distant parts of your body. This is metastatic . Metastatic melanoma spreads most often to the lungs, brain, liver and bones.

    If melanoma spreads, it usually happens within two years of getting a diagnosis. The chance that it will spread is higher if your melanoma was thick or ulcerated , if it was already in your lymph nodes at the time of diagnosis, or if you are older than 50.

    Symptoms If Cancer Has Spread To The Lymph Nodes

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    Lymph nodes are part of a system of tubes and glands in the body that filters body fluids and fights infection.

    The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. Swollen lymph nodes in the neck area can make it hard to swallow.

    Cancer cells can also stop lymph fluid from draining away. This might lead to swelling in the neck or face due to fluid buildup in that area. The swelling is called lymphoedema.

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    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.

    Where Else Does Melanoma Spread To

    When melanoma advances to stage 3, it means the tumor has spread to the lymph nodes or the skin around the primary tumor and lymph nodes. In stage 4, the cancer has moved to other areas far beyond the lymph nodes, like your internal organs. The most common places melanoma spreads to are the:

    • lungs
    • brain
    • stomach, or abdomen

    These growths will cause different symptoms, depending on which areas it has spread to. For example, you may feel breathless or constantly cough if the cancer has spread to your lungs. Or you may have a long-term headache that wont go away if it has spread to your brain. Sometimes the symptoms for stage 4 melanoma may not appear for many years after the original tumor was removed.

    Talk to your doctor if youre feeling new pains and aches or symptoms. Theyll be able to help diagnose the cause and recommend treatment options.

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    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.

    Red Flag #: Abdominal Pain And Tenderness

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    Early on, there may be no noticeable symptoms that melanoma has spread to the liver. When symptoms do show up, they commonly include an enlarged, hard, or tender liver and pain in the upper right area of your abdomen, just below your ribs. Other signs cancer has spread to the liver are similar to symptoms of liver disease: fluid buildup in the belly and yellowing of the skin and eyes .

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    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.

    Symptoms If Cancer Has Spread To The Bone

    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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    Biological Therapies And Melanoma

    Biological therapies are treatments using substances made naturally by the body. Some of these treatments are called immunotherapy because they help the immune system fight the cancer, or they occur naturally as part of the immune system.

    There are many biological therapies being researched and trialled, which in the future may help treat people with melanoma. They include monoclonal antibodies and vaccine therapy.

    The 4 Stages Of Melanoma

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    Two main things determine the stage of melanoma: The thickness or depth of the tumor and how far it has spread when its diagnosed, explains David Polsky, M.D., dermatologist at NYU Langone Medical Center in New York City. In stages 0, 1, and 2, the melanoma is limited to the skin. In stage 3, its spread to the lymph nodes, small structures throughout your body that help filter fluids and fight infection. In the most advanced stage, stage 4, melanoma cells have broken away from the original tumor, traveled through the body and formed a new tumor somewhere else.

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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.

    Symptoms If Cancer Has Spread To The Brain

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

    • headaches
    • weakness of a part of the body
    • fits
    • personality changes or mood changes
    • eyesight changes
    • J Tobias and D HochhauserJohn Wiley and Sons Ltd

    • TNM Staging ChartsLippincott Williams and Wilkins, 2009

    • Improving supportive and palliative care for adults with cancerNational Institute for Clinical Excellence , 2004

    • Oxford Textbook of Palliative MedicineEds D Doyle and othersOxford Universty Press, 3rd edition 2005

    • Cancer and its Management J Tobias and D HochhauserWiley Blackwell, 2015

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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.

    Treating Stage I Melanoma

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    Stage I melanoma is typically treated by wide excision . The width of the margin depends on the thickness and location of the melanoma. Most often, no other treatment is needed.

    Some doctors may recommend a sentinel lymph node biopsy to look for cancer in nearby lymph nodes, especially if the melanoma is stage IB or has other characteristics that make it more likely to have spread. You and your doctor should discuss this option.

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

    If cancer cells are found on the SLNB, a lymph node dissection might be recommended. 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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    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.

    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.

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    Recurrence In Nearby Lymph Nodes

    If nearby lymph nodes weren√Ęt all removed during the initial treatment, the melanoma might come back in these lymph nodes. Lymph node recurrence is treated by lymph node dissection if it can be done, sometimes followed by adjuvant treatments such as radiation therapy and/or immunotherapy or targeted therapy . If surgery is not an option, radiation therapy or systemic treatment can be used.

    Common Places For Melanoma To Spread

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    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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