Brain metastasis is common in patients with malignant mela-noma and represents a significant cause of morbidity and mortality. Nearly 37% of patients with malignant mela-noma eventually develop brain metastasis, and autopsy reports show that 75% of those who died of this disease developed brain metastasis.
Methods
We review the level I and level II evidence that guides indications for treatment with surgery, stereotactic radiosurgery, chemotherapy, and immunotherapy for patients with mela-noma brain metastasis.
Results
Level I evidence supports the role of whole brain radiotherapy, microsurgery, and radiosurgery alone or in combination for the treatment of patients with mela-noma brain metastasis. Chemotherapy has been ineffective. Ongoing studies continue to assess the effects of immunotherapy and agents in development.
Conclusions
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 mela-noma 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 mela-noma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future.
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