Malignant melanoma and central nervous system metastases.Incidence, diagnosis, treatment and survival

Abstract

One hundred and twenty-two patients with clinically advanced, histologically confirmed, cutaneous malignant melanoma, seen at Wayne State University over a 12 year period were reviewed. The incidence of central nervous system metastases (CNS) diagnosed clinically was 46% and at autopsy 75%. Meningeal involvement was suspected clinically in 10.6% and found at autopsy in 52%. Motor dysfunction, mental confusion, cranial nerve disturbance, as well as headache, were the most common manifestations. EEG was found to be extremely sensitive in predicting and confirming CNS metastases even before clinical manifestation. Accuracy increased by performing an EEG serially or combining it with a brain scan. Best therapeutic results were noted after surgery for solitary CNS metastases. Palliative radiotherapy was effective in 37% of patients. Mean survival after neurological diagnosis was 4.0 months, but it varied depending on the site of the initial primary and the presence or absence of other visceral involvement. Concomitant liver metastases carried the worst prognosis. Patients with head, neck or trunk primaries who develop lung or liver metastases should be examined carefully and tested periodically with EEG. Persistent EEG abnormalities should strengthen the clinical suspicion of an underlying CNS metastases and may be an indication for further studies and possible therapy.