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Of all patients who have metastatic disease to the brain, 10% are from skin melanoma. Risk increases with age over 60 years, male gender, disease duration and more advanced tumour/ metastatic stage. BRAF and NRAS mutations, expression of CCR4 receptors on tumour cells, and activation of the PI3K pathway are all risk factors for the development of cerebral metastasis. 80% of melanoma brain metastases are supratentorial. Presentation is often with headache, neurologic deficits and/or seizures. Furthermore, these lesions are at risk of spontaneous haemorrhage. Modern diagnosis is based on neuroimaging and often histology of a stereotactic brain biopsy, if no previous diagnosis has been made. Treatment includes stereotactic radiosurgery (SRS), radiotherapy and/or systemic therapy with “checkpoint inhibitor immunotherapy” or targeted treatments. This has improved median survival upto 11 months in recent years.
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