What Are the Symptoms of Melanoma That Has Spread?

Melanoma that has spread beyond its original skin site produces symptoms that depend almost entirely on where in the body the cancer has landed. There is no single alarm bell. Instead, the signs range from a painless lump near the original mole to seizures, bone pain, or unexplained weight loss, depending on whether tumor cells have reached lymph nodes, lungs, brain, liver, bones, or the gut. Some people have no symptoms at all and learn their melanoma has spread only through routine surveillance imaging.

Swollen Lymph Nodes and In-Transit Lumps

The most common first sign that melanoma is on the move is a swollen or hardened lymph node near the primary tumor. Melanoma cells tend to travel through the lymphatic system before entering the bloodstream, which is why regional lymph nodes are usually the earliest stop. Research has shown that melanoma cells experience less oxidative stress in lymph fluid than in blood, which helps them survive the journey and seed new tumors more effectively.¹ A swollen node may feel firm, round, and painless under the skin in the armpit, groin, or neck, depending on where the original melanoma was located.

Sometimes tumor deposits show up between the primary site and the nearest lymph node basin. These “in-transit” metastases appear as small nodules in or just beneath the skin, and they can be easy to miss on a casual self-exam. In one series, about one in five of these in-transit nodes contained melanoma cells, and in some cases the regional lymph node basin itself was still clear.² A significant share of locoregional metastases are not even palpable. One study found that roughly 29% of regional metastases could not be felt during a clinical exam, with false-negative rates especially high in harder-to-examine areas like the supraclavicular and axillary regions.³

Lung Symptoms

The lungs are one of the most frequent distant destinations for melanoma. In a surgical series, the lung was the single most common site of distant metastasis.⁴ When melanoma reaches the airways, it tends to grow inside the bronchial tubes. That means the symptoms often mimic other lung problems: a persistent cough, coughing up blood, and shortness of breath. Imaging may reveal blocked airways leading to a collapsed lung segment, post-obstructive pneumonia, or fluid collecting around the lung. Some patients instead develop scattered small nodules throughout both lungs or enlarged lymph nodes in the center of the chest.⁵ Because early lung metastases can be small and symptom-free, they are sometimes found only on a routine CT scan before any cough or chest discomfort develops.

Brain and Nervous System Symptoms

Melanoma has a well-known tendency to spread to the brain. The symptoms depend on which part of the brain is involved. The most commonly reported signs are headaches, weakness or difficulty moving a limb, and mental confusion. Cranial nerve problems, such as double vision or facial numbness, also appear frequently.⁶ One particularly alarming presentation is a stroke-like episode. A case report described a 48-year-old woman who suddenly lost part of her visual field; clinicians initially suspected a stroke, but MRI revealed a melanoma metastasis in the occipital lobe. Her symptoms turned out to be caused by seizure activity from the tumor, and they improved once anti-seizure medication was started.⁷ Seizures themselves, whether or not they mimic a stroke, are a recognized symptom of melanoma brain metastases.

A rarer but serious pattern is leptomeningeal disease, where melanoma cells infiltrate the membranes surrounding the brain and spinal cord. Because the cancer spreads along a surface rather than forming a single mass, symptoms can appear in multiple areas at once: headache, nausea and vomiting, double vision, and limb weakness all at the same time.⁸ This multifocal quality, where neurological problems seem too scattered to be explained by a single lesion, is a clinical clue that raises suspicion for leptomeningeal involvement.⁹

Liver Symptoms

Melanoma that reaches the liver often produces vague symptoms that are easy to attribute to other causes. Fatigue, loss of appetite, nausea, and pain in the upper right abdomen are the usual complaints. Blood tests may show mildly elevated liver enzymes and bilirubin, sometimes accompanied by a noticeably high level of lactate dehydrogenase (LDH).¹⁰ In rare cases, liver involvement progresses rapidly to frank liver failure. One case report documented striking rises in LDH preceding fulminant hepatic failure, with biopsy showing melanoma cells packed into the liver’s tiny blood channels.¹¹ Very high LDH in the context of known melanoma should prompt further investigation of the liver.

Ocular melanoma, which arises in the eye rather than the skin, has a distinctive pattern: it spreads preferentially to the liver rather than to the lung. Microscopic tumor clusters have been found in the liver sinusoids of the vast majority of patients with metastatic uveal melanoma studied at autopsy.¹² If you have a history of eye melanoma, liver-related symptoms deserve prompt attention.

Bone Pain and Fractures

Bone metastases from melanoma cause deep, aching pain that tends to worsen at night or with activity and does not improve with rest. The spine, pelvis, and lower extremity bones are commonly affected.¹³ When vertebrae are involved, the tumor can compress the spinal cord, producing symptoms like leg weakness, numbness, or loss of bladder and bowel control. Spinal cord compression is a medical emergency that requires urgent treatment.

Palliative radiation has a strong track record of relieving bone pain from melanoma metastases. In one older but frequently cited study, roughly 85% of treated bone lesions showed a pain response.¹⁴ A later analysis confirmed that radiation relieved bone pain in about two-thirds of cases, with patients typically experiencing relief for roughly half or more of their remaining lifespan.¹⁵ That finding matters because bone pain can be severe and debilitating, and knowing that effective palliation exists is important for anyone facing this symptom.

Gastrointestinal Symptoms

Melanoma spreads to the gut more than most people realize, and the symptoms it causes there are often mistaken for common digestive problems. Abdominal pain, difficulty swallowing, vomiting blood, and dark or tarry stools are all possible signs.¹⁶ In the small bowel, melanoma deposits can grow large enough to obstruct the intestine entirely, causing cramping, bloating, and inability to pass gas or stool. Because these symptoms overlap with more ordinary conditions, GI metastases from melanoma are sometimes diagnosed late.

Whole-Body Symptoms That Signal High Tumor Burden

As melanoma spreads widely, it can trigger systemic effects that are not tied to any single organ. Unintentional weight loss, muscle wasting, and deep fatigue are the hallmarks of cachexia, a wasting syndrome driven by the tumor’s metabolic effects. In a proteomics study, two of three patients with the highest circulating levels of melanoma-derived proteins were suffering from cachexia at the time of enrollment.¹⁷ These whole-body symptoms often appear alongside organ-specific problems, and they tend to signal a high overall tumor burden.

LDH in the blood has long been used as a rough gauge of how much melanoma is present. Elevated LDH correlates with the number of metastatic sites rather than any specific molecular feature of the tumor.¹⁸ The higher the LDH, the worse the prognosis tends to be, with extremely high levels carrying a substantially increased risk of death.¹⁹ Your oncologist may order LDH as part of routine monitoring, and a rising level warrants further investigation even when you feel well.

Unusual and Paraneoplastic Symptoms

Melanoma can produce symptoms that seem to have nothing to do with the tumor itself. These paraneoplastic syndromes occur when the immune system attacks normal tissue in response to the cancer. The most commonly reported one is melanoma-associated retinopathy, where patients experience sudden night blindness, flickering light sensations, and visual field defects. Antibodies produced against melanoma cells cross-react with cells in the retina, damaging normal vision.²⁰ Retinopathy is the most frequently documented paraneoplastic syndrome in melanoma patients overall.²¹

Another rare but distinctive phenomenon is diffuse cutaneous melanosis, where the skin gradually turns a dusky gray-blue color all over the body. This happens when melanoma cells shed melanin precursors into the bloodstream, and the pigment gets deposited widely in the skin. It signals extensive metastatic disease and carries a poor prognosis.²²

When Spread Produces No Symptoms at All

One of the more unsettling realities is that melanoma can spread silently. Surveillance imaging in asymptomatic patients after treatment for stage III melanoma detected distant metastases in about 13% of patients in one study.²³ A separate study using PET/CT scanning found occult disease in about 10% of asymptomatic patients with intermediate to high-risk melanoma.²⁴ These findings are why oncologists typically schedule regular imaging for patients at higher risk of recurrence, even when there are no new complaints. Waiting for symptoms before scanning would miss a meaningful fraction of recurrences at a stage when they might still be treatable.

Mucosal Melanoma Spreads Differently

Not all melanomas originate on sun-exposed skin. Mucosal melanomas arise inside the body, such as in the nasal sinuses, mouth, vagina, or rectum. These subtypes are rare, but their patterns of spread differ from cutaneous melanoma in ways that affect which symptoms appear first. Vaginal melanoma tends to recur locally and spread to the lungs and peritoneum. Anal melanoma preferentially involves the groin lymph nodes. Sinonasal melanoma most commonly reaches the liver and lungs.²⁵ In the head and neck, oral melanomas are more likely to involve regional lymph nodes at the time of diagnosis than sinonasal ones, though distant spread rates are high for both.²⁶ Understanding the primary site helps guide which symptoms to watch for.

Telling Treatment Side Effects from New Spread

Modern melanoma treatments, particularly immunotherapy drugs like nivolumab and ipilimumab, can cause side effects that overlap with the symptoms of metastatic disease. Fatigue, nausea, liver enzyme elevations, neurological symptoms, and even new spots on imaging can all be caused by treatment rather than tumor growth. A phenomenon called pseudo-progression is particularly confusing: tumors appear to grow or new lesions appear on scans shortly after starting immunotherapy, but the apparent growth actually reflects an influx of immune cells into the tumor rather than true cancer advancement. Specialized imaging criteria have been developed to help distinguish pseudo-progression from real progression, though the process remains imperfect and relies on careful evaluation of timing and clinical context.²⁷ If you are on immunotherapy and develop new symptoms, the oncology team will consider both possibilities before making a treatment change.

Radiation for Symptom Relief

When melanoma metastases cause pain, neurological problems, or other disabling symptoms, palliative radiation can provide meaningful relief even when the cancer cannot be cured. For bone metastases, the majority of treated lesions respond with reduced pain. For neurological complications from spinal or nerve involvement, more than half of patients with persistent deficits improved after radiation, and those treated before developing symptoms remained free of neurological problems for most of their remaining lives.¹⁵ A broader review confirmed that radiation provides effective palliation for non-brain melanoma metastases, with higher doses tending to produce longer-lasting relief.²⁸ Melanoma was historically considered resistant to radiation, but these results suggest that framing is too simple; when the goal is symptom control rather than tumor eradication, radiation has a clear role.