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Management of brain metastases in melanoma

Wolfram E Samlowski, MD
Kevin Oh, MD
Julian K Wu, MD
Section Editors
Michael B Atkins, MD
Russell S Berman, MD
Deputy Editors
Michael E Ross, MD
April F Eichler, MD, MPH


Brain metastases are a frequent complication in patients with melanoma. In the past, brain metastases almost invariably contributed to the patients' death. However, major advances in neuroimaging, improved options for the management of brain metastases, and improved management of metastatic disease at systemic sites have substantially improved the prognosis for some of these patients.

Risk factors, prognosis, and management of melanoma brain metastases will be reviewed here. General aspects of the clinical manifestations, diagnosis, and management of cancer-related brain metastases are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of brain metastases".)


Melanoma accounts for about 10 percent of all patients who develop brain metastases. In the United States, only lung and breast cancers are more frequent primary sites associated with brain metastases [1].

In the eighth edition of the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging system for melanoma, brain metastases are separated from other sites of metastasis and form a separate M category, M1d (table 1).

Patients with melanoma limited to the skin and without lymph node involvement (stage I, II (table 2 and table 3)) have a low incidence of brain metastases [2], although younger patients with thick primaries may have an increased risk of late central nervous system (CNS) failure [3]. In patients who presented with advanced regional melanoma (stage IIIB and C), a retrospective analysis of data from the large multi-institutional S0008 adjuvant trial observed a 13 percent incidence of subsequent brain metastases, which occurred predominantly in the first three years after surgery [4].


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