Melanoma is a type of skin cancer that starts in melanocytes. Stage IV melanoma usually means that the cancer has spread to other regions of the body, typically to vital organs and/or soft tissues. This is called metastasis. Metastatic cancer, or a metastatic tumor, is cancer that has grown from where it had originally started.
The goal of treating stage IV melanoma is to control and shrink the metastasis and to relieve symptoms. If the metastatic tumor(s) cannot be removed via surgery, patients are usually recommended to participate in clinical trials or other treatments.
Surgery
Some people can benefit from surgery when treating stage IV melanoma. If the metastasis has only occurred to other areas of skin and/or soft tissues, surgery can be used to remove the the metastatic cancer. Similarly, surgery can be used to remove a single metastatic tumor in the brain, liver, or lungs when there are no other metastasis. People who are considering this surgery must be tested thoroughly through a series of computed tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography (PET) tests to ensure that there are no other metastasis or metastatic areas.
In some cases such as palliative therapy, surgery can be used to relieve symptoms caused by metastasis, such as:
- Anemia caused by bleeding of gastrointestinal metastasis
- Bowel obstruction caused by bowel metastasis
- Ulceration or pain caused by skin or soft tissue metastasis
- Neurological symptoms caused by lymph node metastasis
Chemotherapy
At stage IV melanoma, chemotherapy cannot cure the cancer; however it can be used to control the growth and spread of the cancer, or metastasis. Chemotherapy can also help extend life and/or relieve symptoms caused by the cancer. Some common types of chemotherapy used to treat advanced melanoma are:
- Dacarbazin (DTIC)
- Lomustine (CeeNU, CCNU)
- Temozolomide (Temodal)
Used for malignant melanoma with brain metastasis
Targeted therapy
For those who have stage IV melanoma that cannot be treated by surgery, targeted therapy are offered. The drugs are given by mouth, such as in the form of pills/tablets. Targeted chemotherapy drugs used to treat advanced melanoma are:
- Vemurafenib (Zelboraf)
- Dabrafenib (Tafinlar)
- Trametinib (Mekinist)
- Prembolizumab ()
Biological therapy
Biological therapies are usually given by intravenous (IV) infusion to people with stage IV melanoma, and can include:
- Ipilimumab (Yervoy)
- Interleukin-2 (Aldesleukin, Proleukin)
- -alfa-2b (Intron A)
Radiation therapy
External beam radiation therapy can be used to treat metastatic tumors as well as control symptoms of metastasis. Stereotactic radiation therapy can be used to treat a brain metastatic tumor that cannot be operated on via surgery.
Clinical trials
Some people with melanoma that cannot be operated on via surgery or treated may be offered to participate in clinical trials. Clinical trials are research done through experiments and/or observations to test new ways to prevent, detect, treat, or manage diseases.
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