BRAIN METASTASES IN CHILDREN WITH MELANOMA

BACKGROUND. Brain metastases complicate the course of malignant melano ma in at least 20% of adult cases. These events are commonly preceded by metastases to other sites. Due to the rarity of malignant melanoma in children, little is known about the incidence, clinical features, a nd outcome of children with melanoma who develop brain metastases. MET HODS. The authors reviewed the records of 44 children with malignant m elanoma treated at St. Jude Children's Research Hospital over a 33-yea r period. Eight (18%) developed brain metastases during the course of their disease. The authors reviewed the clinical and radiologic featur es of six of these cases, for whom complete clinical information and i maging studies were available. RESULTS. The median age at diagnosis of malignant melanoma was 15 years (range, 11-21 years). Brain metastase s developed a median of 20 months (range, 0-50 months) after diagnosis and were preceded by metastases to other organs in 5 patients. In mos t cases, lesions were supratentorial and multiple. Most showed radiolo gic signs of intralesional hemorrhage. All patients received whole bra in radiotherapy, and one had surgical resection. Three patients receiv ed chemotherapy. Five patients died a median of 5 months (range, 2-10 months) after diagnosis of brain involvement. One patient, who had a s ingle brain metastasis at diagnosis, is alive more than 34 months late r. CONCLUSIONS. Brain metastases develop in a significant proportion o f children with malignant melanoma and are associated with a poor outc ome. The incidence, features, and outcome in children do not appear to differ from those in adults. (C) 1997 American Cancer Society.