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Published on: February 8, 2017
Prognostic evaluation of intracranial metastasis in malignant melanoma
S Saha1, M Meyer, E T Krementz
1Department of Surgery, College of Human Medicine, Michigan State University, Flint.
Background:
Malignant melanoma (MM) is often reported as the third most common cause of intracranial metastasis (IM) after carcinoma of the breast and lung. Most patients with advanced MM will have widespread extracranial disease, but the majority will die from intracerebral spread.
Methods:
A retrospective review of 117 patients with documented IM from MM over the past 25 years was undertaken. Various factors (including age, race, sex distribution, primary lesions with Clark's level, Breslow's thickness, primary sites and staging at initial presentation, diagnosis of IM and its various treatment methods, survival data, and autopsy findings) were analyzed. Prognostic indicators were clarified from this analysis as a predictor of central nervous system (CNS) metastasis. An ideal treatment plan was also analyzed in order to predict a better survival.
Results:
Fifty-eight percent of patients were male; 42% were female. Seventy-one percent of the primary lesions were of Clark's level IV and V, with mean Breslow's thickness of 3.5 mm. Median time interval between the initial diagnosis and development of IM was 3.5 years. Complete surgical resection of the intracranial lesion in the brain resulted in the longest mean survival of 10.3 months, whereas mean survival for the group with no treatment was only 3 weeks. Patients with primary lesions of the head and neck had the lowest mean survival of 3.3 months, whereas those whose primary sites were unknown had the longest mean survival of 7.5 months. One- and 2-year survival were 9% and 3%, respectively. All but one of the 30 patients at autopsy were found to have visceral metastasis, namely of the lung, liver, and bone.
Conclusion:
An aggressive search for metastasis should be undertaken in patients at high risk of developing CNS metastasis, e.g., male, head and neck primary, Clark's level IV and V, Breslow's thickness of > 3 mm, and presence of visceral metastases, mainly lung. A complete surgical resection should be attempted whenever possible, with adjunctive use of whole-brain irradiation, along with systemic chemotherapy for further control of recurrence and to prolong survival.
Insights
Malignant melanoma frequently spreads to the brain. Complete surgical resection of brain metastases offers the longest survival, emphasizing early detection and aggressive treatment for high-risk patients.
Area of Science:
- Neuro-oncology
- Oncology
- Medical Research
Background:
- Malignant melanoma (MM) is a significant cause of intracranial metastasis (IM), often leading to death despite extracranial disease management.
- Intracerebral spread is a primary cause of mortality in advanced MM patients.
Purpose of the Study:
- To analyze prognostic indicators for central nervous system (CNS) metastasis in MM patients.
- To identify optimal treatment strategies for improving survival in patients with intracranial MM.
Main Methods:
- Retrospective review of 117 patients with MM-IM over 25 years.
- Analysis of patient demographics, primary lesion characteristics (Clark's level, Breslow's thickness), treatment modalities, survival data, and autopsy findings.
- Identification of prognostic factors and evaluation of treatment efficacy.
Main Results:
- Male patients constituted 58%, with 71% of primary lesions at Clark's level IV/V and a mean Breslow's thickness of 3.5 mm.
- Median time to IM diagnosis was 3.5 years; complete surgical resection yielded the longest survival (10.3 months) vs. no treatment (3 weeks).
- Head and neck primaries had the shortest survival (3.3 months), while unknown primaries had longer survival (7.5 months). One- and 2-year survival rates were 9% and 3%.
Conclusions:
- High-risk patients (male, head/neck primary, advanced lesion characteristics, visceral metastases) require aggressive screening for CNS metastasis.
- Complete surgical resection, when feasible, combined with whole-brain irradiation and systemic chemotherapy, is recommended to improve outcomes.
