Diagnosis and treatment of melanoma brain metastasis: a literature review.
BACKGROUND
Brain metastasis is common in patients with malignant melanoma and represents a significant cause of morbidity and mortality. Nearly 37% of patients with malignant melanoma 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 melanoma 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 melanoma 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 melanoma 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 melanoma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future.
Sloan
Andrew E
AE
Brain Tumor & Neuro-Oncology Center and the Neurological Institute, University Hospital Case Medical Center, Cleveland, Ohio 44106, USA. Andrew.Sloan@uhhospitals.org
Nock
Charles J
CJ
Einstein
Douglas B
DB
D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome