title: Cutaneous Melanoma with Brain Metastasis: Report of 193 Patients with New Observations.
abstract: Brain metastasis is a common endpoint in patients suffering from malignant melanoma. However, little is known about factors that predispose to brain metastases.
  
  
  
  We performed a retrospective clinical and pathological investigation of melanoma patients with brain metastases in order to better characterise this patient population.
  
  
  
  193 melanoma patients with brain metastasis histologically diagnosed between 1990 and 2015 at the University Hospital Zurich were retrospectively identified and further specified for sex, age at diagnosis and detection of brain metastasis, and localisation. In addition, data were extracted regarding the subtype of primary melanoma, Breslow tumour thickness, Clark Level, mutation status, extent of metastatic spread and history of a second melanoma.
  
  
  
  We found a significant male predominance (n = 126/193; 65%; p < 0.001). Breslow tumour thickness showed a wide range from 0.2 to 12.0 mm (n = 99; median 2.3 mm). 14 of 101 melanomas (14%) were classified as T1, thereof 11 (79%) were found in men. In 32 of 193 patients (17%), the primary melanoma was unknown.
  
  
  
  Of special interest in our series is the high incidence of male predominance (79%) in cases of thin metastasing melanoma (14%), implicating genetic or epigenetic (hormonal) gender differences underlying tumour progression. Additionally, the high percentage of unknown primary melanoma (17%), at least partly representing completely regressed melanomas, indicates the importance of immune surveillance in melanoma progression.
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Alenka
authors.initials: A
authors.lastname: Gugger
authors.affiliation: Departments of Pathology and Translational Research, Institut Curie, Paris, France.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Barnhill
authors.affiliation: Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Cancer Registry Zurich and Zug, Institute of Surgical Pathology, University Hospital Zurich and Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Dehler
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Moch
authors.affiliation: Departments of Pathology and Translational Research, Institut Curie, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Lugassy
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ewerton
authors.initials: E
authors.lastname: Marques-Maggio
authors.affiliation: Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Rushing
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mihic-Probst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000145:classification / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D012878:Skin Neoplasms / Q000145:classification / Q000453:epidemiology / Q000473:pathology*; D047368:Tumor Burden; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma