Superficial Spreading Melanoma Stage IV

Stage 4 superficial spreading melanoma represents the most advanced phase of the most common type of melanoma, where the cancer has traveled beyond its original location to distant parts of the body such as the lungs, liver, bones, or brain.

Table of contents

• What is Superficial Spreading Melanoma?
• Understanding Stage 4 Melanoma
• Where Can Stage 4 Melanoma Spread?
• How Doctors Diagnose Stage 4 Disease
• Treatment Options
• Outlook and Survival

What is Superficial Spreading Melanoma?

Superficial spreading melanoma is the most common type of melanoma, accounting for approximately 7 out of every 10 people diagnosed with this serious skin cancer^[2]. This form of melanoma develops in melanocytes, which are special cells in your skin that produce melanin, the pigment that gives skin its color^[2].

The name “superficial spreading melanoma” describes how this cancer typically behaves in its early stages. Instead of immediately growing deeper into the skin, these tumors tend to grow slowly outward along the surface of the skin for months, years, or even decades^[2][23]. This horizontal growth pattern is known as the radial growth phase^[23]. The tumor can remain in the same layer of skin cells where it developed for several years before it begins growing into other parts of the skin^[2].

Superficial spreading melanoma can develop on any part of the body. In females, it most commonly appears on the legs, while in males, it typically occurs on the trunk, which includes the head, neck, chest, abdomen, and back^[2][23]. These are areas that tend to receive intense sun exposure at irregular intervals^[2].

Understanding Stage 4 Melanoma

Stage 4 melanoma skin cancer means the disease is advanced^[1]. At this stage, the melanoma has spread to parts of the body away from the original cancer location and further than the nearby lymph nodes^[1]. When cancer spreads from its original location to other parts of the body, doctors call this metastasis or metastatic melanoma^[4].

In the medical staging system called TNM, which stands for Tumor, Node, Metastasis, stage 4 is described as: Any T, Any N, M1^[1]. This means that regardless of the size of the original tumor and whether lymph nodes are involved, the cancer has spread to distant parts of the body.

Stage 4 melanoma is also called distant metastatic or advanced melanoma^[4]. This stage represents a serious medical situation where treatment aims to control the cancer and help relieve symptoms^[1].

Where Can Stage 4 Melanoma Spread?

When melanoma reaches stage 4, it can spread to various parts of the body. The cancer may travel to other areas on the skin or to soft tissue, which includes muscles, nerves, fat, and blood vessels^[1]. Sometimes the melanoma spreads to more than one area at the same time^[1].

The most common places for stage 4 melanoma to spread include^[1][7]:

• Lymph nodes further away from the original melanoma
• Lungs
• Liver
• Bones
• Brain
• Small bowel (part of the digestive system)

The location where the melanoma has spread is called a secondary cancer or metastasis^[1]. Each of these locations may cause different symptoms depending on which organ is affected.

How Doctors Diagnose Stage 4 Disease

To diagnose melanoma and determine if it has reached stage 4, your doctor performs several steps. First, they remove the abnormal area along with a small area of surrounding skin in a procedure called an excision biopsy^[1]. A specialist doctor called a pathologist examines this tissue sample under a microscope to look for melanoma cells and determine the stage of the cancer^[1].

To confirm whether melanoma has spread to other parts of the body and diagnose stage 4 disease, doctors conduct additional tests and scans^[1]. These may include^[8]:

• Blood tests to check blood count and liver function
• Imaging scans such as ultrasound, CT scans, or MRI to see how the cancer has spread
• Additional biopsies to remove samples from areas where the cancer may have spread
• Meetings with a team of skin cancer specialists to review the findings

These tests help doctors understand exactly where the cancer has traveled and plan the most appropriate treatment approach.

Treatment Options

Treatment for stage 4 melanoma depends on several factors, including where the melanoma has spread, your general health and level of fitness, and the location of the original melanoma^[1]. The goal of treatment at this stage is to help control the cancer and relieve symptoms^[1].

Treatment options for stage 4 melanoma have expanded greatly in the last 10 years^[4]. You might receive one or more of the following treatments^[1]:

• Surgery to remove melanoma that has spread
• Targeted cancer drugs that attack specific changes in cancer cells
• Immunotherapy, which helps your immune system fight the cancer
• Radiotherapy to secondary melanoma sites, such as bone or brain
• Injecting medication directly into the melanoma, for example talimogene laherparepvec (T-VEC)
• Chemotherapy delivered directly into the leg or arm where the melanoma is located
• Chemotherapy combined with an electric current
• Chemotherapy into your bloodstream—usually only if you cannot have targeted cancer drugs or immunotherapy

Treatment frequently combines surgery with immunotherapy or targeted therapy^[4]. Newer treatment options, particularly checkpoint inhibitors (a type of immunotherapy), offer the best chances of controlling advanced melanoma and may even cure it in some cases^[26].

Your doctor might ask if you would like to take part in a clinical trial^[1]. Clinical trials offer patients access to treatment approaches that may prove more beneficial than those currently approved. Given the rapid development of new treatments and combinations, doctors highly encourage patients to consider treatment in a clinical trial both for initial treatment and if the disease progresses^[4].

Outlook and Survival

The outlook for stage 4 melanoma has improved significantly with newer treatments. According to current statistics, the 5-year survival rate for stage 4 melanoma is 35 percent^[26]. This means that an estimated 35 out of every 100 people with stage 4 melanoma will be alive 5 years after diagnosis. Some medical centers report that survival rates have increased to 50 percent due to newer treatment options^[8].

It is important to understand that survival rates are estimates based on data from large groups of people and do not predict what will happen to any individual person. Many factors influence a person’s chance of survival, including age, response to treatment, and the availability of new treatment options^[8].

While stage 4 melanoma is serious, newer treatment options can control advanced melanoma for years and even cure it in some cases^[8][26]. The dramatic improvement in quality of life and overall survival for patients with metastatic melanoma has resulted from the development of various new combinations of targeted therapies and different types of immunotherapies.

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