Stage IV melanoma occurs when the cancer spreads beyond the skin to another area of the body. According to the American Academy of Dermatology, the most common sites of melanoma spread include other areas of the skin, lung, liver, brain and small intestines. End-of-life symptoms occur due to the slowed metabolism and circulation, the build up of toxins, the growth of the tumor and multiple organ failure.
Breathing Changes
Circulation and metabolism slow at the end of life with stage IV melanoma. According to the Hospice Foundation of America, breathing patterns change and often include periods of rapid breathing followed by seconds of no breathing. The "death rattle" also occurs occasionally at the end of life. This gurgling or rattling sound that occurs with breathing is due to secretions that accumulate in the back of the throat. This condition causes no discomfort to the patient.
Changes in Circulation
According to the National Cancer Institute, the skin cools, especially in the hands and feet. This occurs due to the decreased circulation of oxygenated blood to the extremities. Also occurring due to this drop in circulation are skin color changes. Pink skin and nails turn gray or blue. A blotchy purple pattern, called mottling, also commonly occurs.
Mental Status Changes
Because of the build up of toxins, metabolism changes and slowed blood flow, confusion and restlessness often occur. The Hospice Foundation of America reports that terminally ill patients often become more withdrawn and sleep increases. At the end of life, a coma-like state usually occurs in which the patient does not wake. Patients at the end of life also commonly report seeing others who have passed away before them and talk about going home or away on a trip.
Melanoma Specific Symptoms
Symptoms also occur that relate specifically to the site of melanoma spread. Patients with widespread melanoma may develop skin sores or ulcerations where the cancer has spread from one area of the skin to another. Melanoma that spreads to the lungs impairs air flow or causes fluid accumulation, resulting in shortness of breath. Pain commonly occurs with cancer and can be felt wherever the cancer spreads. Cancer that spreads to the brain or liver causes symptoms including nausea, confusion, dizziness, and weakness. Melanoma that spreads to the intestines often causes an obstruction.
Other End of Life Indications
Other indicators that occur near the end of life include the decreased need for food and fluids. The body no longer desires normal nutritional requirements. Urine often decreases and becomes dark and concentrated. As muscle groups in the body begin to relax, bowel and bladder control are often lost.
