How Long Before Melanoma Spreads

What If I Have Metastatic Melanoma Symptoms

Whether you have a suspicious mole or are experiencing some symptoms of advanced-stage melanoma, it is important to consult with a physician to receive an accurate diagnosis, as many other conditions can cause similar symptoms. At Moffitt Cancer Center, we provide a comprehensive range of screening, diagnostic, treatment and supportive care services for patients with melanoma and other types of cancer. Within our Cutaneous Oncology Program, our multispecialty team includes surgeons, dermatologists, medical oncologists and other experts who work together as a tumor board to ensure our patients receive the best possible treatment and care.

If you would like to schedule an appointment at Moffitt to discuss your metastatic melanoma symptoms, call or fill out a new patient registration form online. We do not require a referral to schedule an appointment.

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Stop Tumors In Their Tracks

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.

Red Flag #: Bone Pain Or Fractures

The bones are considered a late-stage site of melanoma metastasestypically, it doesnt spread to the bones until its already spread to another area of the body first. Melanoma can cause pain in the bones where its spread, and some peoplethose with very little body fat covering their bonesmay be able to feel a lump or mass. Metastatic melanoma can also weaken the bones, making them fracture or break very easily. This is most common in the arms, legs, and spine. If you feel any sharp, sudden, or new pains that wont go away, talk to your doctor.

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Diagnosis And Staging What It Means For You

How is melanoma diagnosed?

To diagnose melanoma, a dermatologist biopsies the suspicious tissue and sends it to a lab, where a dermatopathologist determines whether cancer cells are present.

After the disease is diagnosed and the type of melanoma is identified, the next step is for your medical team to identify the stage of the disease. This may require additional tests including imaging such as PET scans, CT scans, MRIs and blood tests.

The stage of melanoma is determined by several factors, including how much the cancer has grown, whether the disease has spread and other considerations. Melanoma staging is complex, but crucial. Knowing the stage helps doctors decide how to best treat your disease and predict your chances of recovery.

Skin Exam And Physical

If youve been diagnosed with melanoma, youve already had a skin biopsy. This biopsy was taken when you had part of the suspicious spot removed. After it was removed, a doctor looked at the spot under a microscope to find out if it contained cancer cells. This is currently the only way to tell if someone has skin cancer.

After getting the diagnosis, the next step is to get a complete skin exam and physical.

During the physical, your dermatologist will feel your lymph nodes. This is where melanoma usually goes when it begins to spread. It usually travels to the lymph nodes closest to the melanoma.

If there is a risk the cancer could have spread, your dermatologist may recommend that you have a lymph node biopsy. If a sentinel lymph node biopsy is recommended, it can be performed at the time of your surgery for melanoma.

After the skin exam and physical, your dermatologist may recommend testing, such as a CAT scan, MRI, or a blood test. These can also help detect spread.

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I’ve Been Diagnosed With Melanomawhat Happens Next

Doctors use the TNM system developed by the American Joint Committee on Cancer to begin the staging process. Its a classification based on three key factors:

T stands for the extent of the original tumor, its thickness or how deep it has grown and whether it has ulcerated.

What Is Breslow depth?

Breslow depth is a measurement from the surface of the skin to the deepest component of the melanoma.

Tumor thickness: Known as Breslow thickness or Breslow depth, this is a significant factor in predicting how far a melanoma has advanced. In general, a thinner Breslow depth indicates a smaller chance that the tumor has spread and a better outlook for treatment success. The thicker the melanoma measures, the greater its chance of spreading.

Tumor ulceration: Ulceration is a breakdown of the skin on top of the melanoma. Melanomas with ulceration are more serious because they have a greater risk of spreading, so they are staged higher than tumors without ulceration.

N indicates whether or not the cancer has already spread to nearby lymph nodes. The N category also includes in-transit tumors that have spread beyond the primary tumor toward the local lymph nodes but have not yet reached the lymph nodes.

M represents spread or metastasis to distant lymph nodes or skin sites and organs such as the lungs or brain.

After TNM categories are identified, the overall stage number is assigned. A lower stage number means less progression of the disease.

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.

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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.

What Happens At Follow

The primary purpose of follow-up is to detect recurrences early, but it also offers an opportunity to diagnose a new primary melanoma at the first possible opportunity. A second invasive melanoma occurs in 5-10% patients an unrelated melanoma in situ affects in more than 20% of melanoma patients.

The Australian and New Zealand Guidelines for the Management of Melanoma make the following recommendations for follow-up for patients with invasive melanoma.

• Self-skin examination
• Routine skin checks by a patient’s preferred health professional
• Follow-up intervals are preferably six-monthly for five years for patients with stage 1 disease, three-monthly or four-monthly for five years for patients with stage 2 or 3 disease, and yearly after that for all patients.
• Individual patients needs should be considered before an appropriate follow-up is offered
• Provide education and support to help the patient adjust to their illness

The follow-up appointments may be undertaken by the patient’s general practitioner or specialist, or they may be shared.

Follow-up appointments may include:

• A check of the scar where the primary melanoma was removed
• A feel for the regional lymph nodes
• A general skin examination
• A full physical examination
• In those with many moles or atypical moles, baseline whole-body imaging and sequential macro and dermoscopic images of melanocytic lesions of concern

In those with more advanced primary disease, follow-up may include:

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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 Of Metastatic Melanoma Other Than A Mole

Other symptoms of this type of cancer may not appear until a later stage, when the melanoma has metastasized to another area of the body. Metastatic melanoma most often spreads to the lymph nodes, brain, bones, liver or lungs, and the additional symptoms experienced at this late stage will depend on where the melanoma has spread. For example:

• Lungs A persistent cough or shortness of breath
• Brain Headaches or seizures
• Lymph nodes Swelling of the lymph nodes
• Liver Loss of appetite or unexplained weight loss
• Bone Bone pain or unusual fractures

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Melanoma Can Go Away On Its Own

Melanoma on the skin can spontaneously regress, or begin to, without any treatment. Thats because the bodys immune system is able launch an assault on the disease thats strong enough to spur its retreat. Unfortunately, sometimes this happens only after the disease has spread to other parts of the body, such as the liver, lungs, bones, or brain.

The observation that the immune system can cause melanoma to regress was one of the key insights that led to the development of immunotherapy as a successful treatment for melanoma, explains Dr. Marghoob. The thinking went, if the immune system can get rid of melanoma on its own, there must also be a way to enhance the immune systems natural ability to fight melanoma. This eventually led researchers to develop drugs designed to enhance the immune systems ability to successfully fight melanoma that has spread.

Red Flag #: Abdominal Pain And Tenderness

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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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.

What Is The Treatment For Nodular Melanoma

The initial treatment of primary melanoma is to cut it out the lesion should be completely excised with a 2-3 cm margin of normal tissue. Further treatment depends mainly on the Breslow thickness of the lesion.

After initial excision biopsy the radial excision margins, measured clinically from the edge of the melanoma, recommended in The Australian and New Zealand Guidelines for the Management of Melanoma are shown in the table below. This may necessitate a flap or graft to close the wound. Occasionally, the pathologist will report incomplete excision of the melanoma, despite wide margins. This means further surgery or radiotherapy will be recommended to ensure the tumour has been completely removed.

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Early Detection Prevents Melanoma From Spreading

While there are still many mysteries when it comes to why and how melanoma develops, it is certain that the sooner melanoma is discovered, the lower the chances of it spreading and becoming deadly. Thats why its essential to perform regular skin checks and know the symptoms of melanoma so you can catch it early.

What Are The Stages Of Squamous Cell Carcinoma

Squamous cell carcinoma is classified into the following stages, which are partly based on how far the cancer has spread throughout the body:

• Stage 0 Squamous cell carcinoma develops in the squamous cells, which are located in the epidermis . During Stage 0, the cancer hasnt spread beyond the epidermis.
• Stage 1 When squamous cell carcinoma progresses to Stage 1, it means that the cancer has spread deeper into the skin, but not into any lymph nodes or healthy tissues.
• Stage 2 A Stage 2 classification means that, in addition to progressing deeper into the skin, the cancer also displays at least one high-risk feature. This might include metastasizing to the lower skin layers or the nerves. However, at this stage, the cancer still hasnt spread to lymph nodes or healthy tissues.
• Stage 3 Once squamous cell carcinoma reaches Stage 3, the cancer has spread into lymph nodes but not any other tissues or organs.
• Stage 4 This is the final stage of squamous cell carcinoma, where the cancer has spread to at least one distant organ, whether that be the brain, the lungs or a separate area of skin.

If you think you might have squamous cell carcinoma, its important to seek prompt medical attention to minimize the risk of cancer spread. The specialists in Moffitt Cancer Centers Cutaneous Oncology Program can provide you with the comprehensive diagnostic and treatment services you need. Call or complete our new patient registration form online to request an appointment.

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Should The Lymph Nodes Be Removed

If the local lymph nodes are enlarged due to metastatic melanoma, they should be removed entirely. This requires a surgical procedure, usually under general anaesthetic. If they are not enlarged, they may be tested to see if there is any microscopic spread of melanoma. The test is known as a sentinel node biopsy.

In New Zealand, many surgeons recommend sentinel node biopsy for melanomas thicker than 1 mm, especially in younger persons. However, although the biopsy may help in staging cancer, it does not offer any survival advantage. The necessity for sentinel node biopsy is controversial at present.

Lymph nodes containing metastatic melanoma often increase in size quickly. An involved node is usually non-tender and firm to hard in consistency. If this occurs between planned follow-up visits, let your doctor know promptly.

If the melanoma is widespread, other forms of treatment may be necessary but are not always successful in eradicating cancer. Immunotherapy, biologics such as ipilimumab, and the BRAFinhibitorsdabrafenib and vemurafenib are showing promise.

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.

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Can Metastasis Be Prevented

Melanoma can spread “silently,” meaning that you may not experience any symptoms of metastasis. Therefore, if you’ve been treated for early-stage melanoma in the past, it is extremely important to perform regular self-examinations of your skin and lymph nodes, to keep all your appointments for checkups, and practice sun safety. There is nothing else an individual can do to prevent metastasis from being very diligent.

Catching a recurrence early greatly increases your chances of successful treatment. If the melanoma does spread, it is important to remain positive: remember that while the average prognosis is poor, some people do survive stage IV melanoma.

Skin Cancer Doctor Discussion Guide

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Survival For All Stages Of Melanoma

Generally for people with melanoma in England:

• almost all people will survive their melanoma for 1 year or more after they are diagnosed
• around 90 out of every 100 people will survive their melanoma for 5 years or more after diagnosis
• more than 85 out of every 100 people will survive their melanoma for 10 years or more after they are diagnosed

Cancer survival by stage at diagnosis for England, 2019Office for National Statistics

These figures are for people diagnosed in England between 2013 and 2017.

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.

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