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Management of brain metastases in melanoma

Authors
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

INTRODUCTION

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 "Overview of the clinical manifestations, diagnosis, and management of patients with brain metastases".)

EPIDEMIOLOGY AND CLINICAL PRESENTATION

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].

Patients with melanoma limited to the skin and without lymph node involvement (stage I, II (table 1)) 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].

The risk of brain metastases in advanced melanoma increases with disease duration. In patients with metastatic disease but without brain involvement, a phase III trial comparing dacarbazine and temozolomide found that 20 to 30 percent of patients had brain metastases detected by one year and 30 to 40 percent by three years [5].

                          

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Literature review current through: Mar 2015. | This topic last updated: Apr 16, 2015.
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