The LDH Test for Melanoma and Detection of Metastasis

In This Article
Table of Contents

LDH is a blood test that measures the amount of lactate dehydrogenase (LDH), an enzyme, in your blood. Chemically, LDH works to convert pyruvate to lactate in your body. You may be familiar with lactate, as it is what accumulates in your body after a heavy workout and makes you feel sore.

Overview

In general, LDH is measured to check for tissue damage in areas such as your heart, liver, kidney, skeletal muscle, brain, and lungs — all of which, if injured, elevate the level of LDH in your blood. If you have advanced melanoma, your doctor can use this test to help determine if your cancer has metastasized or spread to organs beyond your skin and lymph nodes. LDH is not commonly ordered for early melanoma. Doctors have found it most reliable in patients with metastatic disease.

Your doctor may check your LDH levels as part of the initial staging of melanoma, particularly if you have advanced disease. LDH levels have implications for prognosis and can be used to monitor response to therapy and to monitor for recurrence of disease.

The most common areas for cancer to progress are usually the liver or lungs. Although LDH is not specific to melanoma, it can be a useful test for diagnosing or monitoring skin cancer post-surgical treatment.  The staging system for melanoma also uses the results of any LDH testing to subdivide patients with stage IV disease.

How the Test Is Performed

To determine your LDH levels, your healthcare provider will draw blood from your vein or from your heel, finger, toe, or earlobe. The laboratory then quickly spins the blood to separate the serum, the liquid portion of your blood, from the blood cells. The LDH test is performed on your blood serum.

Before you have blood drawn, your doctor may ask you to stop taking certain drugs known to affect LDH. Drugs that can increase LDH include alcohol, anesthetics, aspirin, clofibrate, fluorides, mithramycin, narcotics, and procainamide. 

What Test Results Mean

Normal values may vary depending on your age, sex, and the specific method used in the laboratory. The normal reference range is typically 105 to 333 IU/L (international units per liter). The total LDH is often further separated into five components (called isoenzymes) — LDH-1, LDH-2, LDH-3, LDH-4, and LDH-5 — that are specific to certain regions of the body and are expressed as percentages of the total.

LDH level can be elevated in many conditions, not just metastatic melanoma. Higher-than-normal levels may also indicate:

  • Stroke
  • Heart attack
  • Various kinds of anemia
  • Low blood pressure
  • Liver disease (for example, hepatitis)
  • Muscle injury
  • Muscular dystrophy
  • Pancreatitis

Falsely elevated results can happen if the blood specimen was handled roughly, stored in extreme temperatures, or if the sample was difficult to collect.

What Research Shows

Prior studies have shown that an elevated LDH level can predict survival in patients with advanced melanoma. For this reason, LDH was included in the 2002 staging system for melanoma. Patients with stage IV melanoma and elevated LDH have the worst prognosis.

Beyond categorizing patients with stage IV disease, the LDH test is not specific or sensitive enough to detect melanoma before it metastasizes to the lymph nodes. A study followed patients with melanoma for 2.5 years after surgery. The results showed that LDH level was not a good marker for "in-transit metastasis" (stage IIIC melanoma that has spread beyond the skin lesion but not to the lymph nodes) or spread to local lymph nodes. In the study, the LDH test only accurately identified distant metastasis in a minority of patients. A test for another blood protein called S-100B is emerging as a better marker than LDH and may be incorporated into future staging systems.

If your doctor has ordered a test for LDH, or even if the results come back and the level is high, do not panic. A high LDH level does not mean your melanoma has metastasized, it is only a "head's up" for your doctor to investigate the situation further with a CT, PET, or MRI scan or sentinel lymph node biopsy. If you have any questions or concerns about interpreting your LDH test results, be sure to discuss them with your doctor.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Deme D, Telekes A. [Prognostic importance of lactate dehydrogenase (LDH) in oncology]. Orv Hetil. 2017;158(50):1977-1988. doi:10.1556/650.2017.30890

  2. Rogatzki MJ, Ferguson BS, Goodwin ML, Gladden LB. Lactate is always the end product of glycolysisFront Neurosci. 2015;9:22. doi:10.3389/fnins.2015.00022

  3. Starnes JW. Effect of storage conditions on lactate dehydrogenase released from perfused hearts. Int J Cardiol. 2008;127(1):114-6. doi:10.1016/j.ijcard.2007.06.002

  4. Palmer SR, Erickson LA, Ichetovkin I, Knauer DJ, Markovic SN. Circulating serologic and molecular biomarkers in malignant melanomaMayo Clin Proc. 2011;86(10):981–990. doi:10.4065/mcp.2011.0287

  5. Budczies J, von Winterfeld M, Klauschen F, et al. The landscape of metastatic progression patterns across major human cancersOncotarget. 2015;6(1):570–583. doi:10.18632/oncotarget.2677

  6. Trotter SC, Sroa N, Winkelmann RR, Olencki T, Bechtel M. A Global Review of Melanoma Follow-up GuidelinesJ Clin Aesthet Dermatol. 2013;6(9):18–26.

  7. Health and Wellness Library. Lactate dehydrogenase test. Magellan Health Services [internet]. 2010.

  8. LDH isoenzyme blood test. Mount Sinai [internet].

  9. Lactate dehydrogenase test. Allina Health [internet]. 2018.

  10. Teke HÜ, Başak M, Teke D, Kanbay M. Serum Level of Lactate Dehydrogenase is a Useful Clinical Marker to Monitor Progressive Multiple Myeloma Diseases: A Case ReportTurk J Haematol. 2014;31(1):84–87. doi:10.4274/Tjh.2013.0044

  11. U.S National Library of Medicine. Lactate dehydrogenase (LDH) test. Medline Plus [internet]. Updated 26 September 2019.

  12. Lactate dehydrogenase (LD). LabTestsOnline [internet]. Updated 19 November 2019.

  13. Gray MR, Martin del Campo S, Zhang X, et al. Metastatic melanoma: lactate dehydrogenase levels and CT imaging findings of tumor devascularization allow accurate prediction of survival in patients treated with bevacizumabRadiology. 2014;270(2):425–434. doi:10.1148/radiol.13130776

  14. Thompson JA. The revised American Joint Committee on Cancer staging system for melanoma. Semin Oncol. 2002;29(4):361-9. doi:10.1053/sonc.2002.34115

  15. Weinstein D, Leininger J, Hamby C, Safai B. Diagnostic and prognostic biomarkers in melanomaJ Clin Aesthet Dermatol. 2014;7(6):13–24.

  16. Zbytek B, Carlson JA, Granese J, Ross J, Mihm MC Jr, Slominski A. Current concepts of metastasis in melanomaExpert Rev Dermatol. 2008;3(5):569–585. doi:10.1586/17469872.3.5.569

  17. Gogas H, Eggermont AM, Hauschild A, et al. Biomarkers in melanomaAnn Oncol. 2009;20 Suppl 6(Suppl 6):vi8–vi13. doi:10.1093/annonc/mdp251

Additional Reading
  • Egberts F, Hitschler WN, Weichenthal M, Hauschild A. Prospective monitoring of adjuvant treatment in high-risk melanoma patients: lactate dehydrogenase and protein S-100B as indicators of relapse. Melanoma Res. 2009;19(1):31-5. DOI: 10.1097/CMR.0b013e32831993cc.

  • Chun YS, Wang Y, Wang DY, et al. "Prognostic value of S100B levels and LDH levels in melanoma patients" J Clin Oncol 2008 26(May 20 suppl; Abstr 9002).
  • Eggermont AMM. "Reaching First Base in the Treatment of Metastatic Melanoma" J Clin Oncol 2006 24(29):4738-45.