Stage IV melanoma consists of cancer that has spread from the skin to other parts of the body. The top five sites of common spread, according to the American Academy of Dermatology, include other areas of the skin, lungs, liver, brain and small intestines. Symptoms at end of life relate not only to the site of spread but also the process of multiple organ failure that occurs as a result of terminal illness.
Circulation Changes
In the end stages of stage IV melanoma, blood flow decreases throughout the body. As a result, changes in the skin's color and temperature occur. The Hospice Foundation of American state that skin temperature, especially in hands and feet, cool at the end of life. In addition, skin and nail color changes from pink to gray, blue or purple. Blotching of the hands and feet may also occur. Blood pressure slowly drops until no blood pressure remains.
Breathing Changes
Breathing also changes as a result of terminal melanoma. The National Cancer Institute reports that breathing may alternate between fast and slow patterns. A condition known as apnea also commonly occurs close to death and consists of occasional periods where breathing stops.
Congestion commonly referred to as the "death rattle" occasionally occurs due to the accumulation of fluid in the back of the throat. This condition is not thought to cause discomfort or shortness of breath but may be disturbing for family to hear.
Mental Status Changes
Due to the lack of oxygen, slowed metabolism and toxin build up in the blood, changes in wakefulness and cognition occur. Drowsiness increases over time and eventually patients spend most of their time sleeping. The Hospice Foundation of American states that it is not uncommon to enter a coma-like state at the end of life. Confusion and restlessness also occur at the end stages of melanoma.
Melanoma Specific Symptoms
Melanoma that spreads to the lungs causes shortness of breath due to the tumor growth or the build up of fluid in the lungs. Pain can occur anywhere in the body as a result of stage IV melanoma but usually relates the location of cancer spread. Openings or sores develop when cancer spreads to other areas on the skin. Symptoms that occur with spread to the brain and liver include confusion, nausea, dizziness and the risk for bleeding. Melanoma that spreads to the small intestines often causes bowel obstruction.
