Melanoma can spread to other areas in the body, including the lungs, liver, lymph nodes and the brain. It can also affect other areas of skin some distance from where it first started. Melanoma which has spread is called advanced or stage 4 melanoma. Doctors also use terms like secondary or metastatic cancer, which means cancer that has spread from its original site.

The treatment you have will depend on where the melanoma has spread to, your general health, and what treatment you have already had.

You may have several different tests depending on the symptoms you have. These can include:

Blood tests

To check your general health.

Chest x-ray

To check your general health and look for any signs of melanoma in the lungs.

Liver and abdominal ultrasound scan

This uses sound waves to make up a picture of a particular area of the body. Once you are lying comfortably on your back, a gel is spread on your abdomen. A small device like a microphone is then passed over the area. The echoes are converted into a picture by a computer.

CT scan (computerised tomography scan)

A series of x-rays is taken of the chest and abdomen. These are fed into a computer to build up a detailed picture of the body organs and may show whether the melanoma has spread. The scan takes from 10 to 30 minutes. You may be given a drink or injection of a dye which allows particular areas to be seen more clearly. For a few minutes this may make you feel hot all over. If you are allergic to iodine or have asthma, it is important to let your doctor know this beforehand, as you could have a serious reaction to the injection. You will probably be able to go home as soon as the scan is over. Your doctor may also want you to have a CT scan of your brain.

MRI scan (magnetic resonance imaging scan)

This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. You will be asked to lie very still on a couch inside a long tube for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It is also noisy, but you will be given earplugs or headphones. Some people are given an injection of dye into a vein in the arm, but this usually does not cause any discomfort.

Treatment for advanced melanoma aims to slow down the progress of the cancer. It can also help with some of the symptoms. You may want to discuss the aims of treatment with your doctors.

Surgery

If the melanoma is in the skin, the lymph nodes or in a single part of the brain, your doctors may suggest an operation to remove it. Surgery can also be used to help relieve symptoms of advanced melanoma.

Biological therapies

Biological therapies are based on substances naturally produced in the body. The main one used in melanoma treatment is interferon. Interferon is produced by the body to fight viral infections. A man-made version is available. The aim is that interferon will help stimulate the body’s own immune system to fight the cancer. Interferon is given as an injection just under the skin (subcutaneously) usually three times a week. It can cause side effects similar to flu symptoms (fever, chills, headache and tiredness). Although these can be troublesome, they gradually disappear once the treatment is over. Another type of biological therapy is interleukin. This is used more often in the USA. Interleukin tends to cause more side effects than interferon. There is no evidence that either drug is more effective than the other.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. A drug called dacarbazine (DTIC) can be used to treat advanced melanoma. Sometimes it is used with other chemotherapy drugs. Most chemotherapy is given by an infusion (drip) into one of the veins in your arm (intravenously). It is usually given every three or four weeks. Another chemotherapy drug, temozolomide (Temodal®), is also being used in research trials for melanoma.

Isolated limb perfusion

If the secondary melanoma is confined to just an arm or a leg, your doctors may suggest isolated limb perfusion. This is a specialised procedure, only available at some hospitals, which allows chemotherapy to be given to just one limb. The side effects are reduced because the chemotherapy does not affect the rest of the body.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue. It may be used if, for example, cancer has spread to the bones, as it can help relieve pain. It may also be used to treat melanoma in the skin and brain.

Treatment for advanced melanoma can only control the cancer and lead to an improvement in symptoms and quality of life. However, for some people the treatment will have very little effect on the cancer, and they will get the side effects without many of the benefits.

If a cure is not possible and the treatment is being given to control the cancer, you may want to consider whether you wish to have treatment. Making decisions in these circumstances is always difficult, and you may need to discuss your situation in more detail with your doctor. If you choose not to have treatment, you can still be given supportive care, (also known as palliative care) with medicines to control any symptoms.

Cancer vaccines

Vaccines are being researched to see if they are useful to treat melanoma. It is hoped that cancer vaccines will help stimulate the body’s own immune system to destroy the cancer cells.

Biochemotherapy

This treatment uses a biological treatment, such as interferon, in combination with chemotherapy to treat melanoma.