Brenda Spriggs, MD, MPH, MBA
Melanoma is a very dangerous form of skin cancer that readily spreads via lymph nodes to other parts of the body. Melanoma originates in the melanocytes, the cells that produce pigmentation or coloring of our skin, hair and eyes, according to the Skin Cancer Foundation.org. Stage IV melanoma is advanced cancer that has invaded deep into the skin. End of life symptoms of stage IV melanoma can be varied.
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Patients who are gravely ill from stage IV melanoma may have changes in their breathing. Melanoma patients may have metastasis to the lungs. According to the Hospice Foundation, signs of approaching death include what is known as Cheyne-Stokes breathing, named after the person who first described this pattern. This is a period of rapid breathing followed by no breathing at all. Episodic coughing is not uncommon and rales and rattles can often be heard when a dying person breathes. This is a result of the body’s fluids collecting in the lungs. It can be a distressing sound but the Hospice Foundation notes that it is not an indication of pain or suffering.
Central Nervous System Changes
Patients dying of stage IV melanoma may exhibit changes in their mentation. Their activity decreases and they may sleep quite a bit. The Hospice Foundation notes that patients may not respond to conversation or questions. Patients with brain metastasis from the melanoma may lapse into a coma, a deep state of unconsciousness from which they cannot be aroused. Hospice states that even though patients are in a coma they may still hear what is said and feel pain. One of the last senses to go before death is hearing. As patients near death, they may experience sensory changes and hallucinate or hear things that are not there.
Dying patients will exhibit skin changes. The skin becomes cool to the touch as the body temperature decreases. Blood pressure also drops and the extremities become cold due to decreased blood flow. The normal pinkish color of the skin may turn to a dusky, gray color indicating that oxygen is not getting to the tissues.The fingernail beds may turn bluish or grey.
Some patients may suffer with pain as they die due to metastasis to the bone. Others may feel pain because of difficulty breathing. A dying patient need not suffer with pain. Hospice and palliative care teams are equipped to deal with pain and are able to administer medication to alleviate suffering.