Advanced Melanoma: What to Expect

Medically Reviewed by Stephanie S. Gardner, MD on September 18, 2023
4 min read

Melanoma can spread to parts of your body far away from where the cancer started. This is called advanced, metastatic, or stage IV melanoma. It can move to your lungs, liver, brain, bones, digestive system, and lymph nodes. Most people find their skin cancer early, before it has spread. But others find out they have the disease when it’s in an advanced stage. Some people find out it has spread after they’ve had a melanoma removed, sometimes years later.

Melanoma spreads when the tumor's cells travel through your body's tissues, blood, or lymph nodes. They can settle in your organs and keep growing there. They can do this because they’re sneaky. Every day, your body makes cancerous cells. Normally they don’t make it past “checkpoints” in your immune system, which destroys them. But melanoma cells can use these checkpoints to avoid attack.

How the disease makes you feel depends on where in your body the cancer has spread to. For example, if it spreads to lymph nodes, they can get swollen and painful. If the melanoma goes to your lungs, you may have trouble breathing or a cough that won’t go away. If it shows up in your liver, you may have indigestion, a swollen belly, or yellow skin and eyes, a condition called jaundice. In general, though, it’s common for people with advanced melanoma to feel very tired, not feel hungry, and lose weight without trying.

Based on where the disease spreads and how healthy you are, your doctor can suggest some treatments that would help you the most. It’s important to have an open, honest talk with them about the kind of therapy you want, how long you want it, and your goals for your care.

In most cases, treatment can't cure advanced melanoma. But some can help you live longer and feel better. The goal of any therapy you get will be to shrink or remove your tumor, keep the cancer from spreading further, and ease your symptoms.

Surgery. This is the main way to remove melanoma from the skin and lymph nodes. You might also have an operation on organs where the cancer has spread. There’s no guarantee your surgeon will get all of it. Some melanoma is too small to see, even with high-tech scans.

Radiation. Your doctor might recommend radiation to kill any cancer cells that have been left behind after surgery or if melanoma spreads to your brain or bones. It can also relieve pain from the disease or treat melanoma that comes back over and over. 

Immunotherapy or biologic therapy. These drugs help your immune system find and attack cancer cells.  Depending on the ones you take, you might have to go in for treatment every 2, 3, or 4 weeks.

Your doctor might want you to take more than one drug.  Some studies show that people who do have fewer side effects.

The flip side of immunotherapy is that sometimes these drugs cause your immune system to attack healthy organs. Then you’d need to stop melanoma treatment and take drugs to stop the attack.

Targeted therapy. These drugs turn off the genes in melanoma cells that make them grow out of control. Targeted therapy can do a good job at first, but it tends to stop working in time. Then you’d need to try another treatment.

It’s rare, but targeted therapy can cause problems with your heart, liver, kidneys, skin, or eyes. Some people may get a different kind of skin cancer called squamous cell carcinoma. Be sure to check your skin and tell your doctor about any marks that are new, changing, itching, or bleeding.

Chemotherapy. Chemo drugs go through your whole body and attack more rapidly dividing cells, like cancer cells. You get this treatment in cycles that last a few weeks. After a cycle, you have time off to let your body recover.

Chemo can shrink the cancer, but chances are it will start growing again after a few months and you’ll need more treatment. Immunotherapy and targeted therapy usually work better.

Some chemo drugs can damage your nerves and cause pain, burning, tingling, or weakness or make you more sensitive to heat or cold. Those problems usually go away when you stop treatment.  

Other side effects include:

  • Hair loss
  • Mouth sores
  • Infection
  • Bruising or bleeding

Each kind of treatment has its own particular side effects to look out for. But they have some in common:

  • Feeling very tired
  • Changes in your appetite
  • Constipation or diarrhea
  • Itching
  • Rashes

Tell your doctor if you have any side effects, even if they don’t seem too bad. Your doctor can help you manage them or keep them from getting worse.