Management of brain metastases in melanoma
- Marc H Friedberg, MD, PhD
Marc H Friedberg, MD, PhD
- Assistant Clinical Professor
- Tufts University School of Medicine
- Eric T Wong, MD
Eric T Wong, MD
- Associate Professor of Neurology
- Harvard Medical School
- Julian K Wu, MD
Julian K Wu, MD
- Professor of Neurosurgery
- Tufts University School of Medicine
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms
- Section Editor — Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Associate Professor of Surgery
- New York University Langone Medical Center
Melanoma is the third most common cancer causing brain metastases in the United States, after cancers of the lung and breast , which appears to reflect the relative propensity of melanoma to metastasize to the central nervous system (CNS) . Brain metastases are responsible for 20 to 54 percent of deaths in patients with melanoma , and among those with documented brain metastases, these lesions contribute to death in up to 95 percent of cases .
As with other primary tumors, patients with melanoma metastatic to brain typically present with symptoms of increased intracranial pressure (eg, headache), focal neurologic deficits, and/or seizures. Brain metastases from melanoma may have a particularly high propensity for spontaneous hemorrhage.
The risk factors, prognosis, and management of brain metastases will be reviewed here. The general clinical manifestations and diagnosis of brain metastases are discussed separately. (See "Overview of the clinical manifestations, diagnosis, and management of patients with brain metastases".)
Although all patients with melanoma are at risk for metastasis to the brain, certain characteristics that are associated with increased risk of systemic metastases also correlate with the subsequent development of brain metastasis. These factors include [4-7]:
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- Azer MW, Menzies AM, Haydu LE, et al. Patterns of response and progression in patients with BRAF-mutant melanoma metastatic to the brain who were treated with dabrafenib. Cancer 2014; 120:530.
- Dummer R, et al. An open-label pilot study of vemurafenib in previously treated metastatic melanoma patients with brain metastases. J Clin Oncol 2011; 29:537s.
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- Avril MF, Aamdal S, Grob JJ, et al. Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma: a phase III study. J Clin Oncol 2004; 22:1118.
- Giorgio CG, Giuffrida D, Pappalardo A, et al. Oral temozolomide in heavily pre-treated brain metastases from non-small cell lung cancer: phase II study. Lung Cancer 2005; 50:247.
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- RISK FACTORS
- FAVORABLE PROGNOSIS PATIENTS
- Stereotactic radiosurgery
- Adjuvant WBRT
- - Adjuvant WBRT after surgery
- - Adjuvant WBRT after SRS
- POOR PROGNOSIS PATIENTS
- Radiation therapy
- SYSTEMIC THERAPY
- Targeted therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS