In a study presented by Vosoughi, the median time from primary melanoma diagnosis to brain metastasis was 3.2 years and the median overall survival duration from the time of initial brain metastasis was 12.8 months [13].
Many patients do not have any symptoms from the presence of brain metastases. Based on their location and size, however, patients may experience headaches, nausea, vomiting, fatigue, weakness or unsteadiness from the presence of brain metastases.
For stage IV melanoma that has spread to the brain, surgery and radiation can remove small tumors and provide relief from symptoms, but they don't stop disease progression. Median survival for these patients is four-to-five months. Melanoma brain metastases are known to be resistant to multiple types of chemotherapies.
Studies estimate that between 40% to 75% of people whose melanoma spreads will end up with one or more brain metastases. The symptoms of these tumors—which can include seizures, vision and hearing problems, and difficulty thinking and remembering—can be devastating.
When it spreads to an internal organ, such as the brain, a patient has advanced or metastatic (met-ah-stat-ic) cancer. This is stage IV, the most serious stage. Research breakthroughs are helping patients with stage IV melanoma to live longer.
What Is the Recovery Outlook? The median survival time for patients with brain metastasis ranges from 3 to 11 months. The length of survival depends on the patient's age, the extent that the primary disease is under control, and the presence of tumors elsewhere in the body.
Doctors have known for decades that melanoma and many other cancer types tend to spread first into nearby lymph nodes before entering the blood and traveling to distant parts of the body.
Stage IV melanomas have already spread (metastasized) to distant lymph nodes or other areas of the body. Skin tumors or enlarged lymph nodes causing symptoms can often be removed by surgery or treated with radiation therapy.
According to the American Cancer Society , the 5-year survival rate for stage 4 melanoma is 15–20 percent. This means that an estimated 15–20 percent of people with stage 4 melanoma will be alive 5 years after diagnosis.
Though symptoms vary from patient to patient, common brain metastasis symptoms include: Headaches: These are often the first symptoms of a brain metastasis. They are caused by the tumor putting pressure on the brain and skull. A headache caused by brain metastases usually becomes progressively worse as time passes.
They are often described as dull, "pressure-type" headaches, though some patients also experience sharp or "stabbing" pain. They can be localized to a specific area or generalized. They can be made worse with coughing, sneezing or straining.
One of the reasons melanoma is so serious is that it can get into the lymph nodes and the bloodstream, and spread from there to the vital organs. Consequently, cancer that develops in a mole on your back, for example, can migrate to your brain, lungs, bones, liver, or other organs and areas.
With stage IV metastatic melanoma, the cancer has spread to distant regions of the body, mostly commonly the liver, lungs, bones, gastrointestinal tract, and brain. Your doctor will look at two factors to determine how advanced a stage IV melanoma has become.
Once in the brain, metastases can grow quickly and can crowd or destroy nearby brain tissue. A patient may have many brain metastases in several different areas of the brain. Metastatic brain tumors can appear many years after the primary cancer. Others grow so quickly that they are diagnosed before the primary cancer.
It can become life-threatening in as little as 6 weeks and, if untreated, it can spread to other parts of the body.
Even in stage 4, melanoma can still be treated with surgery, chemotherapy, radiation therapy, immunotherapy, and/or targeted therapy. However, once the cancer has spread, it can be difficult to find and treat all the cancerous cells.
Melanoma that has spread to the brain may cause headaches and sickness. These can be worse first thing in the morning. Other symptoms depend on the area of the brain affected. They may include numbness or weakness in a limb, or having a seizure (fit).
Tiredness and feeling unwell
Tiredness (fatigue) is a common symptom of advanced cancer. You may feel that you lack energy, and this can be overwhelming.
Melanoma most often appears on the face or the trunk of affected men. In women, this type of cancer most often develops on the lower legs.
In melanoma, SRS is an established treatment option for the local control of brain metastases. A study of 80 patients treated with immunotherapy after SRS showed 78% of patients were alive at 12 months if treated with nivolumab compared to 68% in patients treated with ipilimumab [9].
The relative 5-year survival rate drops from 99% in stages 1 and 2 to 66.2% in stage 3 to only 27.3% in stage 4. 2 Stage 4 melanoma is very difficult to treat and has a low survival rate because it has metastasized, but a small population of people with this stage of melanoma respond well to treatment.
Practical recommendations: CNS metastases are common in melanoma. MRI screening starting in stage IIc should be considered even in asymptomatic patients. Stage IV requires quarterly MRI examinations. Melanotic and amelanotic metastases show different MRI characteristics.