TREATMENT OF MELANOMA METASTASES IN THE BRAIN

Melanoma is prone to spread to the brain and is the third most common source of intracranial metastasis. Patients usually present with signs and symptoms of increased intracranial pressure, a new focal neurolog ic deficit, or seizures. Contrasted magnetic resonance imaging (MRI) i s the single most valuable imaging modality. Surgical therapy is the a ppropriate choice for single lesions that are accessible, especially i f they are causing significant mass effect or are located in the poste rior fossa. Patients with several intracranial metastases who undergo resection of all lesions may have a similar prognosis to those with a single resected lesion. Stereotactic radiosurgery appears to provide g ood local control of small lesions. External beam radiotherapy may pro vide some benefit to patients, and is often used in conjunction with s urgery or stereotactic radiosurgery. To date, chemotherapy has been li mited because of chemo-resistance and drug delivery issues. Future dir ections for treatment may include local sustained delivery of either c hemotherapy or immunoregulatory molecules. (C) 1996 Wiley-Liss, Inc.