Melanoma brain metastasis

Discuss the different treatment options for melanoma with brain metastasis. 

Brain metastasis is common in melanoma, and treatment options for brain metastasis include surgery, radiation, and chemotherapy. The choice of therapy depends on the number of metastatic lesions, accessibility of the lesions for surgery, the presence of neurologic symptoms, and the status of extracranial disease. 

Brain metastasis is the most common neurologic complication seen in patients with cancer. Approximately 170,000 patients develop brain metastases in the United States each year.20 Many malignancies are frequently associated with brain metastases (Table 96-7). While melanoma is the tumor type most likely to metastasize to the brain, brain metastases owing to lung and breast cancers are seen more often because they are among the most common cancers. In addition, brain metastasis may be diagnosed at the same time as the primary malignancy in around 20% of cases.22 Around 80% of brain metastases occur in the cerebral hemispheres, 15% in the cerebellum, and 5% in the brain stem. 

Similarly, Fidler (F3) found that B16-F1 and F10 melanoma cells produced metastasis exclusively in the lungs. This occurred even though the cells were injected intracardially and thus had to pass through capillary beds of other tissues before reaching the lungs. Other B16 melanoma sublines have been isolated that selectively metastasize to brain, adrenals, and ovaries [reviewed in Nicolson (N3)]. 

Kawaguchi, T., Kawaguchi, M., Miner, K. M., Lembo, T. M. and Nicolson, G. L. (1983). Brain meninges tumor formation by in vivo-selected metastatic B16 melanoma variants in mice. Clin. Exp. Metastasis 1, 247-259. 

Schackert, G. and Fidler, I. J. (1988b) Site-specific metastasis of mouse melanomas and a fibrosarcoma in the brain or meninges of syngeneic animals. Cancer Res. 48, 3478-3484. 

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