Understanding the symptoms of melanoma that has spread is essential for anyone with a history of melanoma or at-risk skin lesions. When melanoma metastasizes, it moves beyond the original skin site to lymph nodes, lungs, liver, brain, or bones, and the symptoms of melanoma that has spread vary depending on where in the body the cancer has traveled.
Melanoma accounts for only about 1% of skin cancers but causes the majority of skin cancer deaths, according to the American Cancer Society. The five-year survival rate for localized melanoma is 99%, but it drops to 35% when the cancer has spread to distant organs. This is why recognizing metastatic symptoms early and seeking treatment promptly can meaningfully affect outcomes. For more on health conditions, see our medical conditions guide.
How Melanoma Spreads
Melanoma can spread through two main routes: the lymphatic system and the bloodstream. The pattern of metastasis typically follows a predictable progression, though exceptions occur.
Local spread: The melanoma first grows deeper into the skin. Satellite lesions (small tumor deposits near the original site) or in-transit metastases (tumor deposits between the original site and the nearest lymph node basin) may develop.
Regional spread: Cancer cells travel through lymphatic vessels to nearby lymph nodes. Swollen lymph nodes near the melanoma site are often the first sign of spread. For a leg melanoma, this means the groin. For an arm melanoma, the axilla (armpit).
Distant spread: Cancer cells enter the bloodstream and travel to distant organs. The most common sites for distant melanoma metastasis are the lungs, liver, brain, bone, and skin/soft tissue at remote locations. Less commonly, melanoma can spread to the gastrointestinal tract, heart, adrenal glands, and kidneys.
The risk of metastasis correlates with the thickness (Breslow depth) of the original melanoma, the presence of ulceration, and the mitotic rate (how quickly the cancer cells are dividing). Melanomas thicker than 4 mm at diagnosis have the highest risk of distant spread.
Swollen Lymph Nodes
Hard, painless, swollen lymph nodes near the original melanoma are one of the earliest and most common signs of regional metastasis. The affected nodes may feel firm or rubbery and are typically fixed in place rather than mobile.
Common locations include the groin (for lower extremity melanomas), the axilla (for upper extremity and trunk melanomas), and the neck (for head and face melanomas). Sometimes the swollen node is discovered before the primary melanoma is even identified, particularly when the original skin lesion was small or in a hidden location.
Not all swollen lymph nodes indicate cancer. Infections, autoimmune conditions, and other factors can cause lymph node enlargement. However, any new, persistent lymph node swelling in a person with a melanoma history should be evaluated promptly with ultrasound and possible biopsy.
Symptoms of Melanoma Spread to the Lungs
The lungs are one of the most common distant sites for melanoma metastasis. Symptoms may not appear until the metastases are substantial.
Pulmonary symptoms include: persistent cough that does not resolve, shortness of breath, chest pain that may worsen with deep breathing or coughing, coughing up blood (hemoptysis), and recurrent respiratory infections.
Small lung metastases are often detected on routine surveillance imaging (CT scans) before they cause symptoms. This is why regular follow-up imaging is critical for patients with a history of intermediate- or high-risk melanoma. The National Comprehensive Cancer Network (NCCN) provides staging-specific surveillance guidelines.
Symptoms of Melanoma Spread to the Brain
Melanoma has a notable tendency to metastasize to the brain. An estimated 40-60% of patients with stage IV melanoma will develop brain metastases at some point during their disease.
Brain metastasis symptoms include: persistent or worsening headaches (especially morning headaches that improve throughout the day), seizures (may be the first indication of brain involvement), weakness or numbness on one side of the body, vision changes including blurred vision and visual field loss, difficulty with speech or comprehension, personality or behavioral changes, nausea and vomiting from increased intracranial pressure, and balance or coordination problems.
Seek emergency medical attention if you experience sudden severe headache, seizures, sudden weakness on one side of the body, or sudden vision loss. These can indicate acute complications from brain metastases, including hemorrhage, which melanoma brain metastases are particularly prone to. For more on brain-related symptoms, see our guide on symptoms of brain tumor.
Symptoms of Melanoma Spread to the Liver
Liver metastases may cause no symptoms initially but can produce significant problems as they grow and compromise liver function.
Liver involvement symptoms include: pain or discomfort in the upper right abdomen, an enlarged liver (hepatomegaly) that may be felt as a firm mass below the right rib cage, jaundice (yellowing of the skin and whites of the eyes), unexplained itching, loss of appetite, nausea, and unexplained weight loss.
Elevated liver enzymes on routine blood work may be the first clue to liver metastases. Alkaline phosphatase, AST, ALT, and lactate dehydrogenase (LDH) are commonly monitored in melanoma follow-up. An elevated LDH level is particularly significant because it is an independent predictor of poor prognosis in metastatic melanoma and is part of the AJCC staging system.
Symptoms of Melanoma Spread to Bone
Bone metastases from melanoma can cause significant pain and disability. While less common than lung, brain, and liver metastases, bone involvement occurs in roughly 10-20% of patients with distant disease.
Bone metastasis symptoms include: persistent, localized bone pain that worsens over time and is often worse at night, pathological fractures (bones breaking with minimal trauma), spinal cord compression if vertebral metastases press on the spinal cord (causing back pain, leg weakness, and bowel or bladder dysfunction, which is a medical emergency), and elevated blood calcium levels (hypercalcemia), which can cause confusion, constipation, excessive thirst, and kidney problems.
Bone metastases are typically identified through CT scans, PET scans, or bone scans. Treatment may include radiation therapy for pain relief, surgery to stabilize fractures, and bisphosphonates or denosumab to strengthen bone. For more on bone-related cancer symptoms, see our article on symptoms of bone cancer.
Systemic Symptoms of Advanced Melanoma
Regardless of which organs are involved, advanced melanoma often produces systemic symptoms that affect the entire body.
Unexplained weight loss: Losing more than 5% of body weight over 6 months without dietary changes is a common cancer warning sign. In melanoma, this may result from liver involvement, reduced appetite, or the metabolic demands of the growing cancer.
Severe fatigue: Overwhelming tiredness that does not improve with rest and interferes with daily functioning. This stems from the body’s immune response to cancer, anemia, and nutritional deficits.
Skin nodules: New, firm lumps under the skin at sites distant from the original melanoma can indicate subcutaneous metastases. These may appear as dark (pigmented) or skin-colored nodules.
Elevated LDH: While not a symptom you can feel, a rising LDH level on blood work is one of the most reliable markers of metastatic melanoma progression.
When to See a Doctor
Anyone with a history of melanoma should maintain regular follow-up appointments and be vigilant about new symptoms. Contact your oncologist or dermatologist if you notice new or persistently swollen lymph nodes, unexplained cough or shortness of breath lasting more than 2-3 weeks, new headaches or neurological symptoms, abdominal pain or yellowing of the skin, unexplained bone pain, new skin lumps or nodules, or unexplained weight loss or persistent fatigue.
Seek emergency care immediately for: seizures, sudden severe headache, sudden weakness or numbness on one side of the body, sudden vision loss, loss of bladder or bowel control, or confusion and disorientation.
Modern immunotherapy treatments, including checkpoint inhibitors like pembrolizumab (Keytruda) and nivolumab (Opdivo), have transformed metastatic melanoma treatment. According to the National Cancer Institute, long-term survival rates for metastatic melanoma have improved dramatically over the past decade. Early detection of metastases allows for more treatment options and better outcomes.
Frequently Asked Questions
How quickly does melanoma spread?
The speed of melanoma spread varies widely. Some melanomas remain localized for years, while others can metastasize within months of diagnosis. Thicker melanomas, those with high mitotic rates, and ulcerated melanomas tend to spread more quickly. Regular follow-up and imaging help catch metastases early.
Can melanoma spread even after the primary tumor is removed?
Yes. Microscopic cancer cells may have already entered the lymphatic system or bloodstream before the original melanoma was removed. This is why patients with deeper melanomas undergo sentinel lymph node biopsy and may receive adjuvant (preventive) immunotherapy. Follow-up surveillance continues for years after initial treatment.
What are the survival rates for metastatic melanoma?
The five-year survival rate for distant metastatic melanoma has improved from about 5% to approximately 35% with the advent of immunotherapy and targeted therapy. Some patients achieve durable complete responses lasting many years. Survival depends on the specific sites of metastasis, LDH level, overall health, and response to treatment.
How is metastatic melanoma treated?
Treatment options include immunotherapy (checkpoint inhibitors), targeted therapy (BRAF/MEK inhibitors for melanomas with BRAF mutations), radiation therapy (especially for brain metastases), surgery for isolated metastases, and clinical trials. Treatment is tailored to the individual based on mutation status, sites of metastasis, and overall health. Many patients respond well to combinations of these approaches.
Does melanoma ever come back after being declared cancer-free?
Melanoma can recur years or even decades after successful initial treatment. Late recurrences, occurring 10-15 years after the original diagnosis, are well documented. This is why lifelong skin surveillance and awareness of metastatic symptoms are recommended for all melanoma survivors.
Stay Vigilant
The symptoms of melanoma that has spread depend on which organs are affected. Swollen lymph nodes, persistent cough, neurological changes, abdominal pain, and bone pain should all prompt urgent evaluation in anyone with a melanoma history. Thanks to advances in immunotherapy, metastatic melanoma is more treatable than ever before, but early detection of spread remains the key to the best possible outcomes. Maintain your follow-up schedule, know the warning signs, and report new symptoms to your oncology team without delay.