Diagnosis and Treatment of mela-noma Brain Metastasis: A Literature Review

Abstract

Brain metastasis is a common and formidable challenge in patients with malignant melanoma. Although there have been no randomized controlled trials exclusively in patients with melanoma brain metastasis, care can be guided by the application of level I evidence for the treatment of brain metastasis in general and phase II studies focusing specifically on melanoma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future.

Melanoma leptomeningeal dissemination following frontoparietal metastasis surgery: Case report and review of the literature

“…Some authors support the combination of surgery followed by radiosurgery and whole-brain radiation as one of the treatment modalities that achieves the longest progression-free survival (4) ( Table I). However, in our patient, resection was followed by whole-brain radiation instead of whole-brain radiation alone (5). Surgery of brain metastases is, however, not free of complications.…”

Editorial: Stage IV melanoma

“…Measurable success in the setting of Stage IV melanoma without CNS spread has been documented, 3 whereas scattered and only smallcohort studies have investigated disease with cranial involvement. 6 The study by Knisely et al published in this issue of the Journal of Neurosurgery adds an intriguing chapter to immune-modulating therapy in the setting of Stage IV melanoma with brain metastases. 4 The authors undertook a retrospective chart review for disease modifiers in 77 patients who had undergone SRS between 2002 and 2010.…”

“…Indeed, various reviews cite a 10%-40% incidence of known brain metastases in patients with systemic melanoma, with up to 75% of cases having autopsy-proven brain involvement. 1,6 Melanoma has the highest frequency of cerebral spread among all primary neoplasms. Coupled with this CNS tropism is the resulting morbidity and mortality incremental to the burden of systemic disease.…”

“…Treatment modifiers, including steroids, surgery, whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and chemotherapy, can extend median survival to a little less than 1 year when delivered in various combinations. 6 In a morbid rendition of whacka-mole, these interventions often quell, for a time, CNS advancement only to allow the systemic disease to advance beyond treatment. 2,5 More recently there has been notable interest in developing immune-modulating therapies as part of the melanoma armamentarium.…”

“…3,8 This strategy is particularly suitable to melanoma, one of the more immunogenic solid tumors. 6 One large Phase III trial for Stage IV melanoma without cranial disease showed improved survival (10.0 vs 6.4 months) with ipilimumab therapy. 3 Therefore, particularly exciting in the Knisely et al review is the suggestion for a first-of-its-kind therapy that offers substantive disease modulation for both cranial and systemic components of Stage IV melanoma.…”