Malignant melanoma and central nervous system metastases.Incidence, diagnosis, treatment and survival

Abstract

One hundred and twenty-two patients with clinically advanced, histologically confirmed, cutaneous malignant melanoma, seen at Wayne State University over a 12 year period were reviewed. The incidence of central nervous system metastases (CNS) diagnosed clinically was 46% and at autopsy 75%.Meningeal involvement was suspected clinically in 10.6% and found at autopsy in 52%. Motor dysfunction, mental confusion, cranial nerve disturbance, as well as headache, were the most common manifestations. EEG was found to be extremely sensitive in predicting and confirming CNS metastases even before clinical manifestation. Accuracy increased by performing an EEG serially or combining it with a brain scan. Best therapeutic results were noted after surgery for solitary CNS metastases.Palliative radiotherapy was effective in 37% of patients. Mean survival after neurological diagnosis was 4.0 months, but it varied depending on the site of the initial primary and the presence or absence of other visceral involvement. Concomitant liver metastases carried the worst prognosis. Patients with head, neck or trunk primaries who develop lung or liver metastases should be examined carefully and tested periodically with EEG. Persistent EEG abnormalities should strengthen the clinical suspicion of an underlying CNS metastases and may be an indication for further studies and possible therapy.Cancer 42:660-668, 1978.ALIGNANT MELANOMA IS THE third most M common cause of central nervous system (CNS) metastases next to carcinoma of the breast and bronchus. The incidence ranged from 1.4% to 15.7% among all patients with malignant diseases.2,26*49,53 The incidence of CNS metastases in patients with malignant melanoma varied from 6%37 to over 90% in some autopsy ~e r i e s .~ The natural course of the disease is generally accepted to be variable and unpredictable from patient to patient. Central nervous system metastasis usually occurs within a few

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

“…They present clinically in 8 -46% of patients and are found at autopsy in 55 -75% (Amer et al, 1978;Patel et al, 1978;Bullard et al, 1981). The prognosis is measured in months and the aim of treatment is palliative.…”

Cerebral metastases of cutaneous melanoma

“…In untreated cases, median survival is only a few weeks (Amer et al, 1978) rising to 3-4 months in treated cases (Gottlieb et al, 1972;Amer et al, 1978;Carella et al, 1980;Zimm et al, 1981;Retsas, 1988). Various therapeutic measures have been assessed including chemotherapy with agents such as cisplatin (Feun et al, 1990), fotemustine (Merimsky et al, 1991), lomustine (Retsas, 1988) and a combination of dacarbazine and fotemustine (Merimsky et al, 1992;Chang et al, 1994).…”

Antidepressant use and risk of central nervous system metastasis

“…Interestingly, melanoma has the highest affinity for brain metastasis and the worst prognosis [5,[131][132][133].…”