title: Primary cerebral malignant melanoma in insular region with extracranial metastasis: case report and review literature.
abstract: BACKGROUND
  Primary brain melanomas are very infrequent and metastasis outside central nervous system very uncommon. There are some cases in the literature about primary melanoma in the temporal lobe; nevertheless, the insular location has never been described.
  
  
  METHODS
  The patient presented as left insular intraparenchymal hematoma with multiple bleedings. Complementary tests did not show any tumoral nor vascular pattern in relation with these bleedings. A complete surgical resection was performed, and the diagnosis of malignant melanoma, with BRAF mutation, was obtained after histology exam. Extension studies were negative for skin or mucous melanoma. 18F-FDG PET/CT was performed and a metastatic lymph node was found. The diagnosis was primary brain melanoma with extracerebral metastasis. Dabrafenib 150 mg/12 h was the only chemotherapy during 5 months. After that, Trametinib 2 mg/24 h was added to the treatment. Eighteen months after surgery, the patient is independent, with stable situation, and without new metastasis.
  
  
  CONCLUSIONS
  Although malignant melanomas have poor prognosis, total surgical resection and new therapies are increasing the overall survival and improving quality of life. In a patient with suspected brain melanoma, in spite of having extracerebral metastasis, aggressive treatment may be considered.
authors: Neurosurgery Department, University Hospital Virgen del Rocío, Av Manuel Siurot s/n, 410013, Seville, Spain. Martta.troya@gmail.com.
authors: Marta
authors: M
authors: Troya-Castilla
authors: Neurosurgery Department, University Hospital Virgen del Rocío, Av Manuel Siurot s/n, 410013, Seville, Spain.
authors: Santiago
authors: S
authors: Rocha-Romero
authors: Neurosurgery Department, University Hospital Virgen del Rocío, Av Manuel Siurot s/n, 410013, Seville, Spain.
authors: Yamin
authors: Y
authors: Chocrón-González
authors: Neurosurgery Department, University Hospital Virgen del Rocío, Av Manuel Siurot s/n, 410013, Seville, Spain.
authors: Francisco Javier
authors: FJ
authors: Márquez-Rivas
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000628:therapy; D011379:Prognosis
keywords: Bleeding; Cerebral; Melanoma; Metastasis; Primary