Stage 4

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

Stage 4 is part of the number staging system. Stage 4 is also called advanced melanoma.

It means the melanoma has spread elsewhere in the body, away from where it started (the primary site) and the nearby lymph nodes.

The most common places for melanoma to spread include the:

  • lungs
  • liver
  • bones
  • brain
  • bowel
  • adrenal glands
  • distant lymph nodes
  • other areas of the skin

TNM stages

Doctors also use another staging system for melanoma called the TNM staging system. It stands for Tumour, Node, Metastasis.

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body


The stage of your cancer helps your doctor to decide what treatment you need. Treatment also depends on:

  • where the melanoma is
  • your general health and level of fitness

Treatment for stage 4 melanoma can help control the cancer and help to relieve symptoms. You might have one or more of the following treatments:

  • surgery
  • targeted cancer drugs
  • immunotherapy
  • radiotherapy to specific sites of melanoma spread, for example the bone or brain
  • injecting a drug directly into the melanoma (intralesional therapy), for example talimogene laherparepvec (T-VEC)
  • laser surgery using a carbon dioxide laser
  • chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
  • chemotherapy combined with an electric current (electrochemotherapy)
  • chemotherapy – usually you would only have chemotherapy if you’re unable to have a targeted cancer drug or immunotherapy
  • take part in a clinical trial

Other number stages

Last reviewed: 
21 May 2020
Next review due: 
21 May 2023
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    American Joint Committee on Cancer
    Springer, 2017

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    D Schadendorf and others
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