# Symptoms and phases of metastatic melanoma
Metastatic melanoma usually follows a predictable pattern of worsening, although the rate and severity vary widely between patients. Below, we describe the main phases, their characteristics and what this means for everyday life.
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Stage IIIC (locally advanced disease with no metastases but high risk)
At this stage, melanoma has recurred in the lymph nodes or skin around the original tumor, but there are no metastases in distant organs (yet). This stage is a critical phase where treatment is aimed at delaying further spread.
**Symptoms and complaints: **
- Visible lumps or swelling in the skin around the original melanoma
- Swollen lymph nodes (e.g. in the neck, armpit, or groin) that are sometimes palpable or visible
- Sometimes mild pain or tenderness in these areas
- Often no general symptoms such as tiredness or weight loss at this stage
- Psychological strain due to the awareness that the cancer has returned
**Meaning for daily life: **
Many patients still feel relatively well physically at this stage, but the mental impact is significant. Regular monitoring visits are intensifying. Skin changes can be visible, which can feel socially burdensome. The focus is on treatment to prevent further spread.
**Figures about this phase: **
For stage IIIC, 5-year survival without recurrence (cancer recurrence) is approximately 40-50%, depending on other risk factors such as thickness of the original melanoma and genetic mutations. These figures come from international records (AJCC, 2017). It is important to emphasize that these are averages across large groups; individual outlook depends heavily on treatment, type of tumour and physical factors that vary from person to person.
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Stage IV: metastatic melanoma - early metastases
This is when melanoma has broken through to distant organs. This can happen via the bloodstream or lymphatic system. At this stage, metastases are detectable in organs elsewhere in the body, and the disease is considered incurable, although treatment still allows prolonging life and improving quality.
**Symptoms and complaints in this phase: **
- **New skin spots or nodules** in areas far from the original tumour (e.g. face, abdomen, limbs)
- **Fatigue** — one of the most common complaints, often disproportionate to the amount of effort
- **Weight loss** without effort
- **Fever or nocturnal sweat attacks** (occurs but is not always present)
- **Respiratory emergency** - may occur due to metastases in lungs
- **Persistent cough** with no apparent cause
- **Abdominal pain or palpable hardening** — in case of liver metastases
- **Headaches, blurred vision, or neurological symptoms** — when the brain is involved (brain metastases)
- **Bone pain** — especially in the lower back, pelvis or ribs, sometimes at risk of fracture
The severity and combination of symptoms depends heavily on *where* the metastases are located.
**Meaning for daily life: **
This stage involves profound changes. Many patients find that simple tasks become tiring. Work is often no longer feasible. Family and loved ones need to help more with household chores. The need for regular hospital visits for scans and treatment is intensifying. Psychologically, this stage is very stressful, because it becomes clear that healing is no longer the goal, but to prolong life and maintain the quality of life.
**Figures about this phase: **
The median overall survival (from stage IV diagnosis to death) for all patients combined was previously approximately 6-9 months (studies from 2010-2015). However, this has changed dramatically due to modern immunotherapies and targeted therapies. Recent research (2024-2026) shows that patients with certain genetic features (such as BRAF mutations) and on new treatments achieve median survivals of 1.5 to 3 years or longer. These are population averages; many patients survive shorter periods, others considerably longer (source: ASCO guidelines, NCCN 2024-2025). Given the rapid progress in treatment, older figures are no longer representative.
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Stage IV: metastatic melanoma - advanced stage
As the disease progresses and more metastases develop, or as metastases grow larger and affect more organs, one speaks of advanced stage IV disease. This can occur months to years after initial metastasis, or can develop rapidly.
**Symptoms and complaints in this phase: **
- **All symptoms of early metastases become more severe**: persistent and progressive fatigue, more obvious weight loss
- **Decreased appetite and altered taste** — many foods taste metallic or unpalatable
- **Nausea and vomiting** — can arise from metastases in stomach, intestines or brain tumors, or from treatment side effects
- **Severe shortness of breath** — feels like exertion, even at rest
- **Chronic pain** — especially with metastases in bones or abdomen; can be severe
- **Cognitive changes** — decreased concentration, forgetfulness (when brain metastases are present)
- **Depression and anxiety** — very common in this stage
- **Sleep disturbances** — due to pain, night sweats, worries
- **Swelling of limbs** — can arise from obstruction of lymph vessels
- **Signs of organ failure**: yellowing of skin/eyes (liver), hydrocephalus (brain), kidney function impairment
**Meaning for daily life: **
In this stage, independence is severely reduced. Many patients need regular help with personal care, nutrition and mobility. Hospital admissions become more frequent. The balance shifts from intensive treatment to palliative care (aimed at comfort and quality of life). At home, many adjustments may be needed: a ground floor bedroom, toilet modifications, medical equipment at home.
**Figures about this phase: **
For patients with advanced stage IV melanoma (multiple metastases in multiple organs, especially with brain or liver metastases) median survival with standard treatment (without effective immunotherapy or targeted therapy) is historically approximately 3-6 months. With modern treatment, certain subgroups can survive longer, but this depends heavily on response to treatment. Approximately 15-25% of patients with stage IV melanoma achieve one year or longer without progression with immunotherapy (NCCN 2024). These are population averages; individual courses vary considerably.
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End stage: terminal melanoma
This is the phase in which the tumor no longer responds to treatment, organ failure begins to occur, and disease burden predominates. This can extend over weeks to months.
**Symptoms and complaints: **
- **Severe, constant fatigue** — many patients can barely get out of bed
- **Severe pain** — despite pain management sometimes difficult to fully control
- **Very reduced food intake** — patient eats and drinks minimally
- **Delirium or decreased consciousness** — due to tumor in brain, toxic substances (tumor byproducts), or medications
- **Labored breathing** — sometimes rattling sound ("death rattle")
- **Urinary and bowel problems** — including incontinence
- **Skin changes** — possible pressure ulcers when immobility occurs
- **Fever** without infection
- **Decreasing consciousness** — patients become sleepless and unresponsive
- **Family reports "saying goodbye" moment**: patient senses approaching end
**Meaning for daily life: **
In this phase, independence is virtually nil. The focus is entirely on comfort, pain management, and emotional/spiritual support. Many patients are cared for at home with the support of palliative care teams, or stay in a hospice. Communication becomes minimal; much attention goes to signs of discomfort, so that symptoms can be adjusted accordingly.
**Figures about this phase: **
The duration of the final stage varies greatly: some patients decline rapidly (weeks), others more gradually (months). The exact timing is impossible to predict. Medical knowledge provides only directions, not exact prognoses.
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When to contact the healthcare provider
It is important that you maintain regular contact with your treatment team, especially when you:
- **Develop new complaints** that worsen quickly: new swellings, severe shortness of breath, sudden headache, visual disturbances
- **Existing symptoms worsen drastically**: pain is no longer under control, fever persists despite medication
- **Side effects of treatment become unbearable**: nausea you cannot cope with, rash, severe fatigue
- **You become psychologically distressed**: feelings of despair, suicidal thoughts, or simply severe anxiety
- **Practical problems arise**: you are afraid to be alone, eating becomes impossible, personal care becomes impossible
These are not reasons to feel guilty or feel "difficult"; these are signals that your care needs to be adjusted or expanded. Your team is there for that.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._