Stage IV melanoma represents an active but varied stage of disease. Therefore, follow-up for patients may be required weekly, monthly, or even every three months. The follow-up schedule should be arranged in accordance with the level of symptoms and anticipated effects of the disease.

Tumor Marker Tests

Tumor markers are substances, such as proteins or enzymes, produced by tumor cells or by the body in response to tumor cells. When tumor cells multiply, tumor markers increase and enter the bloodstream. Tumor marker levels in the blood help evaluate whether treatment is working or if the disease is progressing. Higher levels of tumor marker in the blood usually mean the cancer is more advanced, and a poorer prognosis.

Blood tests for the following tumor markers are currently under investigation for Stage IV melanoma.

• S-100 B and melanoma-inhibiting activity (MIA) are proteins secreted by malignant melanoma cells. They are detected in the blood by immunoassay, a technique of identifying a substance based on its ability to act as an antigen.
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay is a molecular biologic technique commonly used to detect HIV. New RT-PCR assays can detect tyronsinase, an enzyme associated with the production of melanin, and a possible tumor marker for melanoma.

Prognosis

Prognosis for long-term survival is poor, with 1-year survival rates ranging from 41-59%.¹ However, the following factors may provide a relatively more favorable prognosis and help guide decisions about whether to pursue therapy:

• A limited number of sites of disease
• The disease is limited to soft tissues and lymph nodes, versus bone and vital organs
• Stage IV disease does not develop until more than one year after treatment of earlier stage disease
• The occurrence of an observable and favorable response to treatment

Favorable patient factors include a normal appetite, absence of nausea, vomiting, or fever, the ability to conduct daily activities unimpaired, and being female.

See also If Melanoma Recurs.