What should you know about stage four metastatic melanoma?

Metastatic melanoma can involve lymph nodes or distant organs, and the sites involved guide decisions. A biopsy may confirm that a distant spot is melanoma; scans show its location and help measure change. The original skin lesion may be small even when distant disease needs attention. Symptoms can include pain, cough, breathlessness, headaches, weakness, or no symptoms at all, so feeling well does not replace planned assessment.

See the general [Melanoma](/conditions/melanoma/) information and the explanation of [Brain Metastases](/conditions/brain-metastases/).

Your team may recommend immunotherapy or another systemic medicine to reach cancer cells throughout the body. Surgery or radiation can be added for a deposit that is removable, painful, bleeding, pressing on an important structure, or otherwise needs local control. [Tumour Removal Surgery](/treatments/surgical-oncology/tumour-removal-surgery/) and [Skin Cancer Surgery](/treatments/surgical-dermatology/skin-cancer-surgery/) describe local surgical approaches. Keep appointments for blood tests and scans, and report new symptoms before they interfere with daily activities.

Get urgent medical help for a seizure, new weakness, confusion, severe headache, sudden breathlessness, chest pain, coughing blood, persistent vomiting, severe abdominal pain, or inability to pass urine. Contact the treatment team promptly for fever, severe diarrhoea, a spreading rash, worsening jaundice, or rapidly increasing pain. The right service may depend on your team’s instructions, so keep emergency and oncology contact details accessible.

Which areas are metastatic, and has each been confirmed? What treatment should start first and why? What is the role of local surgery or radiation? How will side effects be managed? Is [Follow-Up After Cancer Treatment](/treatments/survivorship-and-rehabilitation/post-treatment-surveillance/) part of the plan if treatment changes or ends?