Background: Brain metastases are a common consequence in patients with stage IV melanoma associated with a grim prognosis. Objective: The objective of this study was the examination of prognostic factors and the evaluation of different treatment options. Methods: A consecutive series of 133 patients with melanoma brain metastases with regard to prognostic factors and the impact on survival were analyzed. Results: 82 patients had involvement of only the cerebrum at the initial diagnosis, whereas in 7 patients only the cerebellum and the brainstem were involved. Seizures (n = 29) were the single most often reported symptom. The overall median survival time was 24 weeks (1–196) from diagnosis of brain metastases. Women had a significantly longer survival with 36 weeks (3–196) compared to 17 weeks (1–159) for men. Multivariate analysis has established as significant prognostic factors: female gender, number of brain metastases, surgery, chemotherapy, radiotherapy and corticosteroid application. Conclusion: With regard to the prognostic factors, an improved survival can be achieved in this patient group using more elective treatment options, also with emphasis on corticosteroids.