Why Is Melanoma So Deadly? And Other Top Skin Cancer Qs
If you or someone you love has just received a diagnosis of stage 4 melanoma, you probably need help—right now—to understand what that means. We asked three melanoma experts to share their knowledge about stage 4 melanoma and offer information and advice on how to deal with the diagnosis. Here are their expert answers to some of your most pressing questions.
What Is Stage 4 Melanoma?
Stage 4 is the most advanced form of melanoma. “It’s when the melanoma has moved from the skin to the brain or another organ,” says Omid Hamid, M.D., director of the melanoma program at Cedars-Sinai The Angeles Clinic and Research Institute. Early on, a change in an existing mole or a new skin growth might signal melanoma, but at stage 4, symptoms are varied. The difficult truth is, if it's not caught early, melanoma will spread quickly, and when it becomes metastatic, it’s not curable. The current median survival rate for stage 4 melanoma is five years, says Dr. Hamid. Deep breath.
Why Is Melanoma So Deadly?
Of the three main skin cancers—basal-cell carcinoma and squamous-cell carcinoma are the other two—melanoma is the least common. But “it accounts for the most deaths because of its ability to spread to organs,” says Ramin Fathi, M.D., board-certified dermatologist and Mohs surgeon at Phoenix Surgical Dermatology Group in Phoenix.
How Is Stage 4 Melanoma Diagnosed?
Regular body checks by a medical professional are crucial, as nine out of 10 melanoma cases are considered preventable. Causes include DNA damage from UV sunlight, genetics and family history, and even indoor tanning, which can increase your risk by 35%, says Rachel Maiman, M.D., clinical instructor in dermatology at Mount Sinai Hospital in New York City. Your doctor may run blood tests, biopsy tissue from a changing skin growth, or use ultrasound scanning or other imaging tools to determine if you have it, and what stage it is in.
How Is Stage 4 Melanoma Different From Early Forms?
“Staging is a way we talk about melanoma’s spread,” says Dr. Fathi. “Stage is determined by several factors, but primarily how much the cancer has grown and whether or not it has metastasized.” Stages 1 to 3 are determined by what the skin cancer looks like under the microscope. “We look for features such as how many millimeters deep the cancer penetrates, if there is ulceration present microscopically, and if there are a large number of cells that are dividing,” he says. At stage 4, the cancer has advanced to distant body areas, lymph nodes or organs.
What’s the First Thing to Do After a Stage 4 Diagnosis?
“With so much information readily available on the internet, it’s easy to panic,” says Dr. Fathi. “So, the first thing you should do when you are diagnosed with stage 4 melanoma is to get all the information you can from your doctor.” Dr. Hamid elaborates. “You should ask: What’s the first therapy I can get? How is it given? What are the side effects? And am I at greater risk of side effects?” he says. Additionally, he adds, “Patients should always get a second opinion.”
How Is Advanced Melanoma Treated?
Skin tumors or enlarged lymph nodes can be surgically removed and, “in some instances, metastases to internal organs can be removed,” says Dr. Maiman. “Metastases that cause symptoms but cannot be removed are typically treated with radiation, immunotherapy, targeted therapy, or chemotherapy.” Adds Dr. Fathi, "Older treatments such as chemotherapy have fallen out of favor because immunotherapies and targeted therapies produce vastly superior results.” Immunotherapy refers to the use of medicine to stimulate the patient’s immune system to destroy cancer calls. Either on its own or in combination, “immunotherapy is most physicians’ first line of therapy,” says Dr. Hamid.
What Is Targeted Therapy for Melanoma?
Unlike chemotherapy, which attacks any kind of quickly dividing cell, targeted drug therapies zero in on specific genetic mutations in the melanoma cells. A board-certified medical oncologist would recommend targeted therapy based on a variety of considerations, including “the genetic profile of the cancer, an assessment of previously tried therapies, extent and location of metastases, the patient’s overall health and ability to tolerate the treatment regimen, review of side effects, and more,” says Dr. Maiman.
What Are the Side Effects of Melanoma Treatment?
All melanoma treatment has side effects—you may have to try more than one therapy to find the best fit for you. Some combinations of these drugs may cause milder flu-like symptoms and some can trigger life-threatening conditions such as lung, liver, and brain inflammation. But everyone’s response is different, so be sure to discuss all the potential risks and benefits to your treatment with your doctor.
Is There Hopeful New Research on Stage 4 Melanoma?
Doctors are encouraged by new studies on treating metastatic melanoma. “Melanoma has become a poster child of how to treat cancer successfully,” Dr. Fathi says. “Compared to 15 years ago, our treatments are far more effective with fewer side effects. We are finding more creative ways to recruit one’s own immune system to treat cancer once thought to be a death sentence.” Dr. Hamid echoes this thinking. “We’re hopeful that we’re finding new therapies from multiple clinical trials,” he says. Physicians are now getting more information from patients’ tumors to help in staging, prognosis, and treatment.
How Can I Find Clinical Trials for Stage 4 Melanoma?
“Discussing your thoughts with your provider about entering a clinical trial and your motivations for doing so is the best first step,” says Dr. Maiman. There’s a screening process for every trial to determine a patient’s eligibility, which varies by study and is typically performed by the doctor conducting the clinical trial. With more than 400 melanoma-focused clinical trials currently recruiting patients, check the National Cancer Institute website and the Melanoma Research Alliance website for studies that may be right for you. A good general resource on clinical trials is the National Institute of Health website.
Omid Hamid, M.D., Director, Melanoma Program, Cedars-Sinai The Angeles Clinic and Research Institute (he is known internationally for his melanoma research)
Ramin Fathi, M.D., board-certified dermatologist and Mohs surgeon at Phoenix Surgical Dermatology Group in Phoenix, AZ
Rachel Maiman, M.D., Clinical Instructor, The Mount Sinai Hospital Department of Dermatology
Number of Deaths and Preventable Deaths: Melanoma Research Foundation. (n.d.) “Melanoma is the Deadliest Form of Skin Cancer.” melanoma.org
Definition of “Median Survival Rate”: National Cancer Institute. (n.d.) “Median Survival.” cancer.gov/publications/dictionaries/cancer-terms/def/median-survival
How a Doctor Diagnoses Stage 4 Melanoma: Skin Cancer Foundation. (n.d.) “Melanoma Stages.” skincancer.org/skin-cancer-information/melanoma/the-stages-of-melanoma/
Melanoma Staging Definition: Cancer.net. (August 2020.) “Melanoma: Staging.” cancer.net/cancer-types/melanoma/stages
Details of Melanoma Stages: Aim at Melanoma Foundation. (n.d.) “Stages of Melanoma.” aimatmelanoma.org/stages-of-melanoma/stage-0-in-situ-melanoma/
Immunotherapy Treatment for Metastatic Melanoma: American Cancer Society. (n.d.) “Immunotherapy for Melanoma Skin Cancer.”
Targeted Therapy Treatment for Metastatic Melanoma: American Cancer Society. (n.d.) “Targeted Therapy Drugs for Melanoma Skin Cancer.” cancer.org/cancer/melanoma-skin-cancer/treating/targeted-therapy.html
Stage 4 Melanoma Treatment Details: American Cancer Society. (August 2019.) “Treatment of Melanoma Skin Cancer, by Stage.” cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.html
Side Effects to Stage 4 Melanoma Treatments: Memorial Sloan Kettering Cancer Center. (n.d.) “Immunotherapy for Melanoma.” mskcc.org/cancer-care/types/melanoma/treatment/immunotherapy-melanoma
Common Immunotherapy Side Effects: Cancer.net. (May 2019.) “Side Effects of Immunotherapy.” cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/side-effects-immunotherapy
Autoimmune Reactions to Immunotherapy: American Cancer Society. (August 2020.) “Immunotherapy for Melanoma Skin Cancer.” cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html#:~:text=Possible%20side%20effects%20of%20immune,side%20effects%20occur%20less%20often.
Description of Melanoma Biomarkers: National Center for Biotechnology Information. (2017.) “Biomarkers in Malignant Melanoma: Recent Trends and Critical Perspective.” ncbi.nlm.nih.gov/books/NBK481856/