Stage IV melanoma means the cancer has spread to other parts of the body, such as the lungs, brain, or other organs and tissue. It may have also spread to lymph nodes that are a good distance from the original tumor.

A change to an existing mole or normal skin can be the first sign that melanoma has spread. But the physical symptoms of stage IV melanoma aren’t the same for everyone. A doctor will diagnose stage IV melanoma by looking at the primary tumor, the spread to nearby lymph nodes, and whether the tumor has spread to different organs. While your doctor won’t base their diagnosis only on what your tumor looks like, part of their diagnosis involves looking at the primary tumor.

This symptom of stage IV melanoma is easier to feel than it is to see. When melanoma spreads to nearby lymph nodes, those nodes may become matted, or joined together. When you press on the matted lymph nodes, they will feel lumpy and hard. A doctor, checking for advanced melanoma, may be the first person to detect this symptom of stage IV melanoma.

The size of the tumor isn’t always the best indicator of skin cancer staging. But the American Joint Commission on Cancer (AJCC) reports that stage IV melanoma tumors tend to be thicker — more than 4 millimeters deep. However, because stage IV melanoma is diagnosed once the melanoma has spread to distant lymph nodes or to other organs, the size of the tumor varies from person to person. Additionally, treatment may shrink the tumor, but the cancer can still metastasize.

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