When melanoma has spread to distant lymph nodes or other internal organs or bones (stage IV), it is known as advanced melanoma or metastatic melanoma.
Treatment for advanced melanoma is complex and it is best that you are treated by a specialist melanoma unit. The team will discuss the best treatment for you based on the thickness of the melanoma and how far the melanoma has spread.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for melanoma can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
In some cases, surgery may be recommended for people with advanced melanoma. Surgery is used to remove melanoma from areas on the skin, lymph nodes, or other organs such as the lung, brain or bowel.
Your suitability for surgery will be discussed with a multidisciplinary team. They will also consider other options including systemic treatment, radiation therapy and other local therapies.
Immunotherapy drugs called checkpoint inhibitors use the body’s own immune system to fight cancer. They have led to great progress in melanoma treatment.
Checkpoint inhibitors do not work for everyone with advanced melanoma, but some people have had very encouraging results. Sometimes more than one drug is used, and different combinations work for different people.
You will usually have checkpoint immunotherapy as an outpatient, and in most cases, the drugs are given into a vein (intravenously). You may have treatment every 2–4 weeks in a repeating cycle for up to two years, but this depends on how the melanoma responds to the drugs and any side effects you have.
Side effects of immunotherapy
The side effects of immunotherapy drugs will vary depending on which drugs you are given, and can be unpredictable. Immunotherapy can cause inflammation in any of the organs in the body, which can lead to side effects such as tiredness, joint pain, diarrhoea, and an itchy rash or other skin problems.
The inflammation can lead to more serious side effects in some people, but this will be monitored closely and managed quickly.
You may have side effects within days of starting immunotherapy, but more often they occur many weeks or months later. When side effects are treated early, they are likely to be less severe and last for a shorter time.
New types of drugs known as targeted therapy attack specific genetic mutations within cancer cells, while minimising harm to healthy cells. They are generally taken as tablets (orally).
Targeted therapy is most commonly used for advanced melanoma that has spread to other organs or if the melanoma has come back after surgery. Several different targeted therapy drugs have been approved for people who have the BRAF mutation. Drugs for NRAS and C-KIT mutations may be available through clinical trials.
Cancer cells may become resistant to targeted therapy drugs over time. If this happens, your doctor will suggest trying another type of systemic therapy.
Side effects of targeted therapy
The side effects of targeted therapy will vary depending on which drugs you are given. Common side effects include fever, tiredness, joint pain, rash and other skin problems, loss of appetite, nausea and diarrhoea.
Radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply and spread. It may be offered on its own or in combination with other treatments:
- when the cancer has spread to the lymph nodes
- after surgery to prevent the melanoma coming back
- as palliative treatment to improve quality of life by relieving pain and other symptoms.
Before starting treatment, you will have a planning appointment where a CT or MRI scan is performed. The technician may make some small permanent tattoos or temporary marks on your skin so that the same area is targeted during each treatment session.
During treatment, you will lie on a table under a machine that aims radiation at the affected part of your body. Treatment sessions are usually given daily over one to four weeks. The number of treatment sessions will depend on the size and location of the tumour, and your general health. Each session takes about 20–30 minutes and is painless.
In some cases, you may be offered a specialised type of treatment that delivers tightly focused beams of high-dose radiation onto the tumour from many different angles.
Side effects of radiation therapy
The side effects you experience will depend on the part of the body that receives radiation therapy and how long you receive treatment. Many people will have temporary side effects, which may build up over time.
Common side effects include tiredness and skin in the treatment area becoming red and sore during or immediately after radiation therapy.
Palliative treatment aims to manage symptoms without trying to cure the disease. It can be used at any stage of advanced cancer to improve quality of life and does not mean giving up hope. Rather, it is about living for as long as possible in the most satisfying way you can.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, practical, emotional, spiritual and social needs.
Find out more
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Expert content reviewers:
A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, NSW; Craig Brewer, Consumer; Prof Bryan Burmeister, Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Tamara Dawson, Consumer, Melanoma & Skin Cancer Advocacy Network; Prof Georgina Long, Co-Medical Director, Melanoma Institute Australia, and Chair, Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, NSW; A/Prof Alexander Menzies, Medical Oncologist, Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Paige Preston, Chair, Cancer Council’s National Skin Cancer Committee, Cancer Council Australia; Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland Diamantina Institute, and Director, Dermatology Department, Princess Alexandra Hospital, QLD; Julie Teraci, Clinical Nurse Consultant and Coordinator, WA Kirkbride Melanoma Advisory Service, WA.
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The information on this webpage was adapted from Understanding Melanoma - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in July 2021.