Miliary brain metastases from malignant melanoma

Malignant melanoma represents the third most common cause for central nervous system metastases after breast and lung cancer. Whereas breast, lung and kidney metastases are predominantly solitaire, malignant melanoma metastasizes often in a multiple way. Nevertheless, only about 5% of the patients with multiple melanoma metastases have more than five intracerebral metastatic lesions. The case of disseminated carcinomatous cell spreading throughout the brain is called "miliary metastases" or "carcinomatous encephalitis". This condition is very rare and correlated with a poor prognosis. We describe the case of a female patient with neuroradiologically diagnosed miliary brain metastases occurring five years after surgical excision of a forearm malignant melanoma. The clinical signs, diagnosis, and etiology of this rare phenomenon are discussed.