Questions about metastatic melanoma with multi Mets

@angelicbreeze: Thank you for coming to Mayo Clinic Connect, an online support forum for patients, family and caregivers where we as mentors and other contributors, such as yourself, can exchange experiences, emotional support and general tips.

I'm sorry to hear about your husband's fairly recent diagnosis of stage 4 metastatic melanoma although it appears as if he was able to get started on immunotherapy rather quickly after the initial findings. I was also diagnosed with stage 4 MM and started on Keytruda (monotherapy) a month later, in November of 2025, that has been effective to date. These new treatments have been remarkably effective in treating even advanced and complex presentations, such as your husband's, and one reason a PET scan is performed to evaluate the effectiveness. Sometimes an initial PET scan can show growth even though the immunotherapy is working, an effect known as "pseudoprogression" - essentially, the tumor has become swollen in response, much as say a joint may swell after injury. Radiologists must review the imaging to determine this.

I'm not sure what you mean by "and the dr on this site either information" but Mayo Clinic Connect is a peer support network; we do not have medical professionals on staff to provide medical advice, recommendations or review records. Those findings would need to be discussed with the professional(s) overseeing care to your husband. Hopefully, this backgound information has provided some backgroud and guidance. This is an overall guideline for people dealing with this condition that I found helpful: https://www.mayoclinic.org/diseases-conditions/melanoma/diagnosis-treatment/drc-20374888

Has this helped to answer some of your concerns?

@grammato3
Sorry there was a typo in my first post. The main thing Iam curious about is if the dr says immunotherapy isn’t working, are there other treatments options to try? Like targeted rads? And with the primary tumor being so large. Does the immunotherapy work more on that tumor vs its attacks all the tumors at the same pace and rate?

@angelicbreeze: I understand, there are a lot of unknowns with immunotherapy and response to treatment when dealing with multiple mets. Generally, immunotherapy works by activating T-cells to destroy the metastatic tumors wherever they're located, however, those tumors may not all respond the same way. So you pose a good question, and that is way the imaging is performed as routinely as it is: so the oncology team can assess how well the therapy is working on all of the sites. Depending upon the results, the team can then decide upon what next steps to take as there may be secondary lines of treatment to consider.

It may help to be familiar with potential additional treatments of which there can be alternatives offered in many cases. Organizations such as the Melanoma Research Foundation (https://melanoma.org/), Melanoma Research Alliance (https://www.curemelanoma.org/) and AIM with Immunotherapy (https://aimwithimmunotherapy.org/) provide helpful information about these.

Waiting to see how immunotherapy is working can be one of the hardest parts of treatment. There's bound to be some anxiety before undergoing surveillance scans; I still experience a degree of this and I'm sure I will again next month before my PET scan and brain imaging. I've found this article from Australia to ease some of that anxiety: https://melanoma.org.au/news/coping-with-scanxiety/

When is your husband's next imaging scheduled? Will he have the opportunity to discuss the results with the oncology team shortly afterwards?