Chapter 5 – Brain Metastases from Melanoma

Brain metastases are common in patients with metastatic melanoma and the majority of patients who die of the disease do so as a direct result of them. Not only does the diagnosis of brain metastasis signify a very poor prognosis, but it portends a severe impact on the patient’s quality of life. The major clinical problem of melanoma brain metastases has in the past been addressed by treatment with local therapies—surgery and radiation therapy—but the results have been unimpressive, with median survival times of just a few months reported in most series, little better than the survival times of patients offered supportive care only. However, in recent times more effective and less morbid techniques for both the surgical management of brain metastases and the treatment of them using new radiation therapy methodologies have been introduced and, at last, systemic therapies that can treat melanoma brain metastases effectively have been discovered. In this chapter the range of treatments now available to treat melanoma brain metastases will be discussed, outcomes achieved by their use will be presented, and the importance of a multidisciplinary approach to management of the problem will be emphasized.