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Ask the Expert: What is the connection between melanoma and brain metastases?

What is the connection between melanoma and brain metastases?Brain metastases occur when existing cancer cells grow to form one or more secondary tumors that invade the nervous system. While any cancer can spread to the brain, the likelihood is greater with some types of cancer, including melanoma, lung and breast cancer.

Melanoma is a type of skin cancer that can often spread to other parts of the body if not recognized and treated early. Melanoma accounts for approximately 10% of all brain metastasis cases, and nearly 30% of all patients with newly diagnosed metastatic melanoma will see their cancer spread to the brain.

The symptoms of brain metastases will vary depending on their location and may include headaches, neurologic deficits and seizures. Occasionally, the symptoms may occur suddenly, like with a stroke, due to bleeding from these tumors in the brain. Many patients, however, have no symptoms and so the metastases are found incidentally during routine brain imaging performed on patients who are at high risk to have their cancer spread, like those patients with melanoma.

Historically, the treatment of brain metastasis was restricted to surgery and radiation therapy. These were generally associated with poor outcomes. Now, more localized forms of radiation, called stereotactic radiosurgery, allow for targeting the metastasis while decreasing the risk of the long-term side effects associated with giving radiation to the entire brain. Systemic therapies, like chemotherapy, had a limited role in managing brain metastasis, as the nervous system is protected by the blood-brain barrier that limits access to the affected areas of the brain. Therefore, medications that work to treat primary cancers in the body may not work for brain metastases.

In this new era of cancer treatment, use of immunotherapy that stimulates the immune system to recognize and attack cancer cells, combined with more targeted agents, are options that can treat whole-body cancer, as well as brain metastases. These new treatments are particularly effective for brain metastases from melanoma. As a result, patients are living longer and with better cancer control, though there are still many instances in which these treatments are not fully effective.

Several factors influence the outcomes of patients with melanoma and brain metastases. Given the complex decision-making involved in these cases, a team that provides coordinated and consistent care will best serve patients. At UVa Health, we have developed a multidisciplinary Brain Metastasis Program that brings together doctors from several specialties, experienced nurses and many supportive care professionals to develop personalized treatment plans for patients while providing clinical trials that offer access to new, potentially more effective treatment options.

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