Stage IV Melanoma

In Stage IV, the melanoma has traveled beyond the regional lymph nodes to more distant areas of the body. The most common sites of metastasis are to vital organs (lungs, abdominal organs, brain, and bone) and soft tissues (skin, subcutaneous tissues, and distant lymph nodes).

Stage IV: Melanoma 'metastasis beyond regional lymph nodes'

Subclasses M1a, M1b, M1c

Characterized by:
Location of different metastases
Number and size of tumors
Elevated LDH

M1a: spread to distant skin, the subcutaneous layer or to distant lymph nodes. LDH is normal
M1b: the tumor has metastasized to the lung. LDH is normal
M1c: tumor has metastasized to vital organs other than the lungs, and serum LDH is normal
or
There are any distant metastases with elevated LDH

Stage IV Melanoma Primary Characteristics Include:

  • Location of distant metastases
  • Number and size of tumors
  • Elevated LDH levels usually indicate that the tumor has spread to internal organs

There Are 3 Subclasses of Stage IV Melanoma:

The subclasses are based on where the metastases are located and the level of LDH. It does not include any T or N classification.

  • M1a: the tumor has metastasized to distant skin, the subcutaneous layer or to distant lymph nodes. LDH is normal
  • M1b: the tumor has metastasized to the lungs. LDH is normal
  • M1c:
    • the tumor has metastasized to organs other than the lungs, and LDH is normal, OR
    • there are any distant metastases with elevated LDH

Why the Location of Metastases Is Important

Large-scale studies indicate that the respective 1, 2, and 5 year survival rates for Stage IV melanoma are1:

  • Distant skin, soft tissue, and/or lymph nodes – 62%, 43%, 28%
  • Lung – 53%, 31%, 15%,
  • Visceral – 33%, 18%, 9%

Why Brain Metastases Are Different

While brain metastases are part of Stage IV, the risk factors, diagnosis, and treatment, are different than other types of metastases.

Why LDH Levels Are Important

Compared with the survival of patients with normal LDH levels, patients with high LDH levels have significantly worse overall survival. The respective 1, 2, and 5 year survival rates were2:

  • Abnormal LDH – 33%, 18%, 10%
  • Normal LDH – 61%, 33%, 18%
Learn about Stage IV follow-up

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References:

1. Balch CM, Buzaid AC, Soong S-J, et al. Final version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma. J Clin Oncol. 2001;19(16):3635-3648.
2. Gershenwald JE, Morton DL, Thompson JF, et al, Collaborators of the AJCC/UICC Melanoma Task Force. Staging and Prognostic Factors for Stage IV Melanoma: Initial Results of an American Joint Committee on Cancer (AJCC) International Evidence-based Assessment of 4,895 Melanoma Patients. J Clin Oncol. 2008;26(May 20 suppl; abstr 9035). Abstract presented at American Society of Clinical Oncology (ASCO) 2008 Annual Meeting.

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