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Metastatic Melanoma to the Brain: Surgery and Radiation Is Still the Standard of Care

  • Skin Cancer (WH Sharfman, Section Editor)
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Opinion statement

Malignant melanoma with brain metastases remains a difficult disease to treat. Patients presenting with disease affecting the central nervous system (CNS) have a poor prognosis. Treatment depends on a number of factors, including the size and number of lesions, performance status, comorbidities, and presenting symptoms. Physicians and patients must weigh risks and benefits of treatments, with the main goal of palliating symptoms and decreasing the risk of neurological death. Opinions throughout the country vary, but first-line treatment for brain metastases is local therapy involving either craniotomy or stereotactic radiosurgery (SRS) using CyberKnife or Gamma Knife, with or without whole brain radiation therapy (WBRT). Clinical trials remain another option for patients, with chemotherapy reserved for patients who have exhausted other options. There has been a recent surge in knowledge regarding the pathophysiology and treatment of metastatic melanoma leading to recent FDA approval in 2011 of new drugs: ipilimumab, a novel immune therapy, and vemurafenib, which blocks the MAP Kinase pathway. These drugs have the potential to treat patients with metastatic melanoma to the brain but are still undergoing clinical investigation. Despite these recent advances, the prognosis is poor, with few patients able to achieve durable and long-lasting response. Treatment for patients with brain metastases continues to lag behind treatment of other diseases, partly due to their exclusion from early clinical trials.

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Acknowledgments

This work was supported by a grant from the Doris Duke Charitable Foundation to Johns Hopkins University School of Medicine to fund Clinical Research Fellow Sarah Nicholas.

Conflicts of Interest

Sarah Nicholas declares that she has no conflicts of interest.

Dimitrios Mathios declares that he has no conflicts of interest.

Christopher Jackson declares that he has no conflicts of interest.

Michael Lim declares that he has no conflicts of interest.

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Authors and Affiliations

  1. School of Medicine, University of Maryland, Baltimore, MD, 21201, USA

    Sarah Nicholas BS

  2. Department of Neurosurgery, The Johns Hopkins Hospital University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA

    Dimitrios Mathios MD, Christopher Jackson BA & Michael Lim MD

  3. Department of Oncology, The Johns Hopkins Hospital University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA

    Michael Lim MD

  4. 1650 Orleans Street, Bunting Blaustein Cancer Research Building Room 424, Baltimore, MD, 21231, USA

    Sarah Nicholas BS, Dimitrios Mathios MD & Christopher Jackson BA

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Correspondence to Michael Lim MD.

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Nicholas, S., Mathios, D., Jackson, C. et al. Metastatic Melanoma to the Brain: Surgery and Radiation Is Still the Standard of Care. Curr. Treat. Options in Oncol. 14, 264–279 (2013). https://doi.org/10.1007/s11864-013-0228-6

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