An evaluation of the surgical management of melanoma of the brain

Thirty‐two patients with histologically proved metastatic malignant melanoma of the brain were evaluated. Intracranial surgery was performed in 19 and was considered not indicated in 13 patients. Following intracranial surgery, satisfactory improvement in neurologic deficits was observed in 14 (74%) patients. The median survival after occurrence of brain metastases was 5–6 months (1 – 15 months) for the surgical group; and for the nonsurgical group, patients with multiple brain metastases and multiple visceral involvement did not survive beyond a median of 1 month (range 0.5–6 months). Intratumor hemorrhage with substantial intracerebral hematoma was present in 7 (41%) out of 17 craniotomies. The overall incidence of intratumor hemorrhage found at autopsy was 59% for the entire series. Among ail the cases with intratumor hemorrhage, only 2 patients who received chemotherapy after craniotomy developed thrombocytopenia with fatal intracranial hemorrhage. The latter cause‐and‐effect correlation could not be assessed in the other patients. As a result of this retrospective study, we have observed that patients with malignant melanoma and evidence of single brain metastasis without multiple visceral involvement seemed to benefit more from palliative surgery. Moreover, intratumor hemorrhage was a frequent occurrence and should be considered in the differential diagnosis of a patient with malignant melanoma and rapid deterioration of neurologic deficits.