Brain metastases are a common and devastating complication in patients with malignant melanoma. Therapeutic options for these patients are limited, and the prognosis is usually poor.
Object. A retrospective review of 6953 patients with melanoma treated at a single institution was undertaken to identify demographic factors associated with the development of clinically significant brain metastases in 702 of these patients and to determine the factors influencing the prognosis of this population to permit more informed recommendations regarding surgical therapy.
Methods. Factors found to be associated with the development of brain metastases included male gender, primary lesions located on mucosal surfaces or on the skin of the trunk or head and neck, thick or ulcerated primary lesions, and histological findings of acral lentiginous or nodular lesions. The overall median survival time of all patients with brain metastases was 113.2 days, and these metastases contributed to the death of 94.5% of the patients in this group. Patients with primary lesions located in the head or neck region had a significantly shorter survival time relative to other patients with brain metastases, whereas patients with a single brain metastasis, patients without lung or multiple other visceral metastases, and patients whose initial presentation with melanoma included a brain metastasis had a significantly better prognosis. The small group of patients who survived for more than 3 years was characterized by the presence of a surgically treated, single brain metastasis in the absence of other visceral metastatic disease.
Conclusions. Although most patients with brain metastases resulting from melanoma have a dismal prognosis, some who are likely to survive for longer periods can be identified. In these patients surgical resection can significantly prolong meaningful survival. The decision to recommend surgery should be based primarily on the resectability of the brain metastases and on the status and number of other organs with metastatic lesions.
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Figures
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Graphs with plots of actuarial survival curves. Upper: Graph showing overall survival of patients with brain metastases from melanoma. The median survival is 113.2 days. Lower: Graph showing relationship between survival and number of brain metastases in patients with brain metastases from malignant melanoma. The median survival time with a single metastasis (151 patients) was 216.4 days, with two metastases (51 patients) it was 127.2 days, and with more than two metastases (183 patients) it was 85.8 days (p < 0.00001, multiple pairwise comparison). -
View in gallery
Graphs with plots of actuarial survival curves. Upper: Graph showing relationship between survival and visceral metastases in patients with brain metastases from malignant melanoma. Metastasis to one other organ in addition to the brain does not alter expected survival time unless this organ is the lung. The median survival time for patients with isolated brain metastasis (380 patients) was 135.2 days. In the presence of coexisting lung metastasis (191 patients) this was significantly reduced, to 93.8 days (p = 0.0014). With more than one additional site of visceral metastasis (77 patients) median survival was further reduced, to 39 days (p = 0.0036). Lower: Graph showing unexpected survival advantage in patients whose primary presentation at the time melanoma was diagnosed consisted of a brain metastasis (32 patients). The median survival in the initial brain metastases group (204.5 days) was significantly longer than the median survival in the group that presented with brain metastases some time after their initial diagnosis with melanoma (102.3 days, p = 0.0021). -
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Graphs with plots of actuarial survival curves. Upper: Graph showing survival of patients treated with surgery, WBRT, or palliative systemic therapy only (p < 0.0001, craniotomy compared with radiation therapy; p = 0.0006, radiation therapy compared with palliative systemic therapy). Lower: Graph showing relationship between survival and postoperative WBRT (p = 0.9998).
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