Stage IV is divided into stages IVA and IVB. In stage IVA, most of the skin is reddened and any amount of the skin surface is covered with patches, papules, plaques, or tumors, and either (1) cancer has spread to lymph nodes and there may be cancerous lymphocytes in the blood; or (2) there are cancerous lymphocytes in the blood and lymph nodes may be enlarged, but cancer has not spread to them. In stage IVB, most of the skin is reddened and any amount of the skin surface is covered with patches, papules, plaques, or tumors. Cancer has spread to other organs in the body. Lymph nodes may be enlarged and cancer may have spread to them. There may be cancerous lymphocytes in the blood.