DEMOGRAPHICS, PROGNOSIS, AND THERAPY IN 702 PATIENTS WITH BRAIN METASTASES FROM MALIGNANT-MELANOMA

Brain metastases are a common and devastating complication in patients with malignant melanoma. Therapeutic options for these patients are l imited, and the prognosis is usually poor. Object. A retrospective rev iew of 6953 patients with melanoma treated at a single institution was undertaken to identify demographic factors associated with the develo pment of clinically significant brain metastases in 702 of these patie nts and to determine the factors influencing the prognosis of this pop ulation to permit more informed recommendations regarding surgical the rapy. Methods. Factors found to be associated with the development of brain metastases included male gender, primary lesions located on muco sal surfaces or on the skin of the trunk or head and neck, thick or ul cerated primary lesions, and histological findings of acral lentiginou s or nodular lesions. The overall median survival time of all patients with brain metastases was 113.2 days, and these metastases contribute d to the death of 94.5% of the patients in this group. Patients with p rimary 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 lu ng or multiple other visceral metastases, and patients whose initial p resentation with melanoma included a brain metastasis had a significan tly better prognosis. The small group of patients who survived for mor e than 3 years was characterized by the presence of a surgically treat ed, single brain metastasis in the absence of other visceral metastati c disease. Conclusions. Although most patients with brain metastases r esulting from melanoma have a dismal prognosis, some who are likely to survive for longer periods can be identified. In these patients surgi cal resection can significantly prolong meaningful survival. The decis ion to recommend surgery should be based primarily on the resectabilit y of the brain metastases and on the status and number of other organs with metastatic lesions.