What does a stage 4 diagnosis of melanoma mean?

Stage 4 is the most advanced phase of melanoma, a serious form of skin cancer. This means the cancer has spread from the lymph nodes to other organs, most often the lungs. Some doctors also refer to stage 4 melanoma as advanced melanoma.

To diagnose stage 4 melanoma, your doctor will conduct:

  • blood tests, to look at blood count and liver function
  • scans, such as ultrasound and imaging, to look at how the cancer has spread
  • biopsies, to remove a sample for examination
  • multidisciplinary team meetings, or meetings with a team of skin cancer specialists

Sometimes melanoma can reoccur after it’s been removed.

Your doctor will look at where the cancer has spread and your elevated serum lactate dehydrogenase (LDH) level to determine how far into stage 4 the cancer is. Read on to find out what the symptoms of stage 4 melanoma look like.

A change to an existing mole or skin can be the first sign that the cancer has spread. But the physical symptoms of stage 4 melanoma aren’t the same for everyone.

A doctor will diagnose stage 4 melanoma by looking at the primary tumor, the spread to nearby lymph nodes, and whether the tumor has spread to different organs. While your doctor won’t base their diagnosis only on what the tumor looks like, part of their diagnosis involves looking at the primary tumor.

Tumor matting

This symptom of stage 4 melanoma is easier to feel than it is to see. When melanoma spreads to nearby lymph nodes, those nodes may become matted or joined together. When you press on the matted lymph nodes, they will feel lumpy and hard. A doctor, checking for advanced melanoma, may be the first person to detect this symptom.

Tumor size

The size of the tumor isn’t always the best indicator of skin cancer staging. But the American Joint Commission on Cancer reports that stage 4 melanoma tumors tend to be thicker — more than 4 millimeters deep.

However, because stage 4 melanoma is diagnosed once the melanoma has spread to distant lymph nodes or to other organs, the size of the tumor varies from person to person. Additionally, treatment may shrink the tumor, but the cancer can still metastasize.

Tumor ulceration

Some skin cancer tumors develop an ulceration, or a break in the skin. This opening can begin as early as stage 1 melanoma and continue into more advanced stages. If you have stage 4 melanoma, your skin tumor may or may not be broken and bleeding.

According to the American Cancer Society, melanomas that have ulcerations indicate a lower survival rate.


You can also follow the ABCDEs to examine yourself for melanoma. Look for:

  • Asymmetry: when the mole is uneven
  • Border: an irregular or poorly defined border
  • Color: a variation of color on the mole
  • Diameter: melanomas are usually the size of pencil erasers or larger
  • Evolving: a change in the shape, size, or color of the mole or lesion

Talk with your doctor if you notice a new mole or skin lesion on your body, especially if you’ve previously received a melanoma diagnosis.

When melanoma advances to stage 3, the tumor has spread to the lymph nodes or the skin around the primary tumor and lymph nodes. In stage 4, the cancer has moved to other areas far beyond the lymph nodes, like your internal organs. The most common places melanoma spreads to are:

  • lungs
  • liver
  • bones
  • brain
  • stomach, or abdomen

These growths will cause different symptoms, depending on which areas it has spread. For example, you may feel breathless or constantly cough if it has spread to your lungs. Or you may have a long-term headache that won’t go away if it has spread to your brain. Sometimes the symptoms of stage 4 melanoma may not appear for many years after the original tumor was removed.

Talk with your doctor if you’re feeling new pains and aches or symptoms. They’ll be able to help diagnose the cause and recommend treatment options.

The good news is that stage 4 melanoma can be treated. The sooner the cancer is found, the sooner it can be removed — and the higher your chances are for recovery. Stage 4 melanoma also has the most treatment options, but these options depend on:

  • where the cancer is
  • where the cancer has spread
  • your symptoms
  • how advanced the cancer has become
  • your age and overall health

How you respond to treatment also affects your treatment options. The five standard treatments for melanoma are:

  • surgery to remove the primary tumor and affected lymph nodes
  • chemotherapy to stop growth of cancer cells
  • radiation therapy, which applies high-energy X-rays to inhibit growth and cancer cells
  • immunotherapy treatment to boost your immune system
  • targeted therapy, which uses drugs or other substances to attack cancer cells

Other treatments may also depend on where the cancer has spread to. Your doctor will discuss your options with you to help map out a treatment plan.

Clinical trials

Many of today’s treatments for cancer were based on early clinical trials. You may want to participate in a clinical trial for melanoma, especially if it’s melanoma that can’t be removed by surgery.

Each trial will have criteria. Some require people who have not yet received treatment while others test for new ways to reduce cancer side effects. You can find clinical trials through the Melanoma Research Foundation or the National Cancer Institute.

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 of death related to melanoma is 7,650 people per year. The outlook for stage 4 melanoma depends on how the cancer has spread. It’s usually better if the cancer has only spread to distant parts of the skin and lymph nodes instead of other organs.

Survival rates

In 2017, the 5-year survival rate for distant stage melanoma was about 30 percent. Keep in mind that this number reflects the available treatments at the time. Treatments are always advancing, and these rates are only estimates. Your outlook also depends on your response to the treatment and other factors such as age, location of the cancer, and if you have a weakened immune system.

A cancer diagnosis of any type can be overwhelming. Learning more about your condition and treatment options can help you feel more in control of your future. Also, informing your friends and family about each step of your journey may help as you progress through your treatment.

Talk with your doctor about your outlook and potential clinical trials if you’re a suitable candidate. You can also reach out to local community support groups to share your experience and learn about how other people overcame similar challenges. The group AIM at Melanoma has a list of melanoma support groups across the country.