Metastatic vs. Non-Metastatic definition?

Posted By
2/16/2017 2:18pm
Replies: 7

All of my lymph nodes which tested positive are in the same "field / mat" under my arm (primary was on my chest).

Does the term metastatic come from the fact I may have micro-metastize particles which can travel throughout my blood and lymph system?

I'm having a hard time distinguishing between stage 3 and 4, but it seems like the difference is in where the melanoma is found and not necessarily a difference in prognosis.

I can see the difference between stage 2 and 3 being prognostically significant because at stage 2 the melanoma has only been "found" in the skin. However, just because it hasn't been found in other places doesn't mean the micro particles haven't started spreading to anywhere else.

ok, I started out with a question and ended up scaring myself.

Stage III is basically considered "regional" metastasis.  That means it has left the primary site and has traveled (typically via the lymph vessels) to the nearest lymph node basin.  Or an intransit lesion is between the primary site and the lymph node basin.  Lymph nodes are waste collectors and can catch all the cells.  However, cells can continue to move past the sentinel node if given time.  So the primary method of spread is via lymph nodes which always travel to a sentinel node in the regional lymph basin.  If the primary is not removed, it can continue to grow and may eventually send cells via the blood supply as well.  If it is removed and the lymph nodes have caught all the cells, a stage III person CAN actually be melanoma free and never deal with it again.  I believe the number is around 30% of stage III who have their melanoma removed never have a recurrence.  But the other 2/3 will see melanoma again in some form.

Melanoma can also travel via the blood supply.  Not as often initially, but there are some who can go from stage I/II to stage IV without ever having any lymph node involvement.  If melanoma is found beyond the nearest lymph node basin (regardless if it is in an organ, lymph node or on the skin) it has become distant spread.  So stage III is regional and stage IV is distant.

There currently is no blood test to detect melanoma cells circulating in your system.  So you cannot know if you are one who had everything removed via surgery or if there are really microscopic cells floating around looking to take root. 

Hi  .Janner,

Cancer research UK has funded work in to liquid biopsies and identifying circulating tumour cells for melanoma. Not yet being used in clinical practice, probably hugely expensive... But they think it will enable them to determine if treatment is working or if say Braf mek resistance is setting in theory should help plan treatment decisions. Think will only detect circulating cells beyond a given threshold so not as uyet proven to be useful in predicting who will progress but given time who knows. I donate tissue and bloods to the biobank which allows them to testo the accuracy of various biomarkers against known disease progress etc. Think the Manchester team are also trying to identify other biomarkers for likely success of immunotherapy. My blood samples go over to the research institute next door to the hospital as soon as collected. Not a lot of published papers yet.. But will post a link when have access to a laptop. The researchers are working hard on behalf of us all and the increase in knowledge and treatments has been stunning. Just hope the pace is fast enough to translate to translate to better personalised treatments with more success and fewer side effects for those who will not benefit.



THere have been the promise of blood markers for a long time, but they just haven't been up to snuff when tested.  Hopefully things are changing in that arena.  High risk people, treatment options, and other things.  It's great that you donate.  I participated in a trial for genetic markers and familial melanoma, but they aren't too interested in us early stagers for most research.  Glad some are willing to contribute!!! 

Hey Janner,

Long may you stay at the stage where the researchers aren't too interested in your bloods etc

This is a link to the paper  chose this source as it gives full text but you can see citations etc on the usual places where just the abstract is published.



I would like to add to the discussion of blood markers. Last week I have tried the Guardant 360 test that looks for fractions of tumour DNA in the blood. It tells if you have some mutations going thus confirming if cancer is present in the blood. I'll report back when I getmy results 

guardant Health 

Just wondering your results from the Guardant 360 test, my entire family has or has had melanoma and my brother and dad are fighting it now andit feels like it's a stand still with stage 3a...maybe this would be a good test for them. Thanks and hope all is well. 

Stephanie M.

Sorry for this delay. My results came back as no mutations found in the blood sample. Meaning as of Feb 2017, my blood did not show any ctDNA for any of the genes they are able to detect. (Asco 2017 now reporting about the added prognostic value in following ctDNA in patients...) This is five months after my WLE and SLNB which showed "rare isolated cells" in one node. I chose to forego interferon and CLND so far. I plan to redo the Guardant 360 in Feb 2018 to see where I'm at. I also did quite a few more blood tests including Cellsearch for melanoma, ISET, Oncoblot and RGCC Onconomics plus. As of this time of me writing, Oncoblot did detect presence of Enox2 protein (for prostate, not melanoma. A bit surprised about not finding melanoma and not so much for prostate - father, uncle and grandfather all had prostate cancer). But mainly, RGCC in May 2017 found early cancer with melanoma markers. Circulating melanoma cells at 3.1/ml of blood. Three months later, through proposed "natural treatments" from this test, I have apparently been able to lower my count to 2.2 melanoma cells/ml of blood. This is below their limit of advanced disease of 5 tumor cells/ml for melanoma (different threshold for other cancers). All this to say that I am following much more closely than regular "standard of care" scans, hoping to never progress to end stage and trying to get rid of CTCs and CSCs.