title: Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades.
abstract: OBJECTIVE
  The aim of this study was to review the outcome of patients who underwent surgery for treatment of cerebral metastatic melanoma.
  
  
  METHODS
  A retrospective analysis was performed in 147 patients with cerebral metastases from melanoma who were treated surgically at a single institution between 1979 and 1999. Almost all patients underwent postoperative wholebrain radiation therapy. The mean patient age was 53 years (range 17-76 years); 69% of patients were male. A single cerebral metastasis was identified in 84% of patients, although 56% had synchronous extracranial metastases. The 30-day postoperative mortality rate was 2% and neurological symptoms resolved or improved in 78% of patients. Recurrence of intracerebral disease was seen in 55% of patients and 26% died of intracerebral metastases. Twenty-four patients underwent reoperation for recurrent cerebral disease. The median survival duration from the time of surgery for all patients was 8.5 months; the 3- and 5-year survival rates were 9% and 5%, respectively. Factors that significantly influenced survival on univariate analysis were the number of cerebral metastases (p = 0.015), a macroscopically complete excision (p < 0.05), and reoperation for recurrence (p = 0.02). The presence of extracranial metastases did not significantly influence survival. On multivariate analysis only the number of cerebral metastases significantly affected survival (p = 0.04).
  
  
  CONCLUSIONS
  For the majority of patients with cerebral metastases from melanoma, surgery with adjuvant radiation therapy is a treatment option that improves neurological symptoms and produces minimal morbidity. Long-term survival (> 3 years) most likely occurs in patients with a single cerebral metastasis and no demonstrable extracranial disease. Reoperation for recurrent cerebral disease may be appropriate in selected cases.
authors.affiliation: Department of Neurosurgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. azacest@mail.eisa.net.au
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Zacest
authors.forename: Michael
authors.initials: M
authors.lastname: Besser
authors.forename: Graham
authors.initials: G
authors.lastname: Stevens
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: William H
authors.initials: WH
authors.lastname: McCarthy
authors.forename: Gordana
authors.initials: G
authors.lastname: Culjak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed