Metastatic melanoma is an advanced form of skin cancer that occurs when melanoma cells spread from their original location to other parts of the body. Symptoms vary depending on the organs affected and may include swollen lymph nodes, persistent pain, fatigue, breathing difficulties, or neurological changes. Treatment approaches depend on the cancer's stage, genetic characteristics, overall health, and previous therapies.
Metastatic melanoma develops when melanoma, a cancer that begins in pigment-producing cells called melanocytes, spreads beyond its original site. It may affect nearby lymph nodes or distant organs, including the lungs, liver, brain, and bones. Although advanced melanoma can be challenging to treat, developments in immunotherapy and targeted therapy have expanded treatment options. Early recognition of concerning symptoms and appropriate medical evaluation are important for determining the extent of the disease and selecting an individualized treatment plan.
Symptoms depend on where the cancer has spread, and some individuals may initially experience few noticeable changes. Skin changes can remain relevant, but metastatic disease may also produce symptoms unrelated to the original melanoma. A healthcare professional evaluates symptoms, medical history, and examination findings to determine whether further testing is necessary.
Common symptoms and diagnostic approaches include:
Skin changes: New or changing moles, unusual pigmented spots, or lumps beneath the skin may occur. However, metastatic melanoma can develop without an obvious new skin lesion.
Swollen lymph nodes: Enlarged or firm lymph nodes, particularly near a previous melanoma site, may indicate possible spread.
General symptoms: Persistent fatigue, unexplained weight loss, reduced appetite, or ongoing pain may occur.
Organ specific symptoms: Lung involvement may cause coughing or shortness of breath. Liver involvement can produce abdominal discomfort, while brain metastases may cause headaches, seizures, weakness, or changes in vision.
Diagnostic tests: Doctors may recommend a biopsy, blood tests, imaging studies such as CT or PET scans, and MRI scans when brain involvement is suspected. Tumor testing may identify genetic changes, including BRAF mutations, that influence treatment selection.
These symptoms can have causes other than melanoma. New, persistent, or worsening symptoms warrant medical assessment, especially in someone with a history of melanoma.
Treatment depends on the location and extent of the cancer, tumor characteristics, previous treatment, and the patient's overall health. A multidisciplinary team may include medical oncologists, surgeons, radiation oncologists, and other specialists. Treatment goals can include controlling cancer growth, reducing symptoms, preserving quality of life, and extending survival.
Available approaches may include:
Immunotherapy: Medicines called immune checkpoint inhibitors, including pembrolizumab, nivolumab, and ipilimumab, help the immune system recognize and attack cancer cells. These treatments can produce durable responses in some patients, although immune-related side effects may affect different organs.
Targeted therapy: For melanomas with specific genetic alterations, particularly BRAF mutations, combinations of BRAF and MEK inhibitors may slow or reduce tumor growth. Genetic testing helps determine whether these medicines are appropriate.
Surgery: Selected patients may benefit from removing isolated metastases or treating particular sites of disease. Surgery is not suitable for every case of metastatic melanoma.
Radiation therapy: Radiation may help control tumors in specific locations, relieve pain, or treat brain metastases. Its role depends on the disease pattern and other treatments being used.
Clinical trials and supportive care: Clinical trials may provide access to investigational treatments. Supportive care can help manage pain, fatigue, treatment side effects, and emotional challenges throughout treatment.
Regular follow-up helps clinicians evaluate treatment response, monitor side effects, and adjust care when necessary. Patients should discuss the potential benefits, risks, and limitations of each option with their healthcare team to understand which approach best fits their circumstances.