Brain Melanoma khaled abdeen

1. Presentation and Surgical
Implications of Brain
Melanomas
Osama S. Abdelaziz, M.D, Khaled Abdeen,
M.D , Waleed F. El-Saadany, M.D, Alaa I.
Issa, M.D, Khaled G. Aref, M.D.
Department of Neurosurgery,
Faculty of Medicine, Alexandria
University, Egypt

3. • Malignant melanomas are uncommon,
accounting for 1.5 % of all malignant tumors and
for about 12% of brain metastases
• Malignant brain melanomas are mostly metastatic
from primary extracranial malignant melanomas of
various locations and rarely primary brain
melanomas. The present study will correlate the
clinical and radiological presentations and will
address the role of surgery for brain melanomas.

4. • Primary melanocytic neoplasms of the
brain develop from normally existing
leptomenigeal melanocytes with a
predilection to the pons, cerebellum,
cerebral peduncles, medulla,
interpeduncular fossa and the inferior
surface of the frontal, temporal and
occipital lobes. These neoplasms are
generally divided into three main types:
diffuse melanosis, meningeal
melanocytoma and primary malignant
melanoma .

5. Material and methods
• Eight patients (5 males and 3 females) with
an age range of 1.5 to 70 years (median 36
years). Seven patients had metastatic brain
melanomas (one of them had xeroderma
pigmentosa) and one had primary brain
melanoma (in a patient with neurocutaneous
melanosis (NCM) syndrome).

6. • All patients had brain CT scan and only 5 patients
had brain MRI. Five patients had metastases
confined to the brain, one patient had both brain and
lung metastases, and another had metastases to both
the brain and the gastrointestinal tract. All patients
had surgery for solitary or multiple symptomatic
brain lesions.

7. Demographic characteristic of 8 patients with
metastatic brain melanoma
Age:
< 40y
>40y
3
5
Gender :
male: female 3:5
Location of primary melanoma
Trunk
Head&neck
Upper extermity
Lower extermity
eye
3
2
1
1
1
Histologic type
Superficial spreading
Acral lentigious
nodular
4
2
1

8. Clinical presentation
Presentation No.of cases
-Focal neurological deficit
- Seizures
- Mental changes
- Deteriorated consciousness
- Increased ICP
5
3
3
3
3

9. Types of therapies for 8 patients with
brain melanoma
therapy No. of cases
Surgery +WBRT
Surgery +chemotherapy
Surgery alone
WBRT alone
Chemotherapy alone
5
2
1 [primary melanoma NCM]
--
----

11. Neurocutaneous melanosis
• Neurocutaneous melanosis is charachterized
by : large or multiple congenital naevi
associated with malignant melanoma or
meningeal melanosis, primarily in children
and may be associated with other congenital
abnormalities including Dandy –walker and
spina bifida.

18. Hemorrhagic presentation

22. RESULTS
• At the time of the last follow up, five patients with
metastatic brain melanomas [62.5%] had improved
neurological signs, two patients [25%] showed
stabilization of their neurological status.
Conversely, in one patient [12.5%] the neurological
symptoms worsened. All 7 patients with metastatic
brain melanomas died. Death was attributed in
whole or in part to brain metastases in 5 patients
while the other two patients succumbed to
melanoma outside the brain.

23. Results
• The overall median survival time for patients with
brain metastases was 4 months from the time of
surgery and 6 months from the diagnosis of brain
tumors. The patient with primary brain
melanoma in a neurocutaneous melanosis (NCM)
syndrome remained clinically stable until her
death, from recurrent disseminated malignant
disease within the brain, two months
postoperatively.

24. Conclusion
• Surgery for isolated cerebral metastasis can
result in neurological improvement but may
not be of value in patients with multiple
lesions and extensive extracerebral spread.