Question Title: melanoma brain tumor.. doctors unsure

Forum: Neurology Forum
Topic: Stroke

Posted by CCF Neurosurgery MD on October 29, 1997 at 16:51:11:

In Reply to: melanoma brain tumor.. doctors unsure posted by Leah H. Kocia on October 29, 1997 at 11:14:45:

My father has recently been diagnosed with a malignant brain tumor. Two years ago he had a melanoma tumor removed from the top of his skull directly beneath the skin. One month ago he experienced a mini stroke which led the doctors to the tumor in his brain. They have concluded from recent testing that the tumor is two inches in diameter. The doctors are unsure of whether they can safely operate or if radiation is the only answer. Please send any advice or additional treatment methods.

Any information would be greatly appreciated. Thank-you for your time and effort.

Leah

Dear Leah,

Melanoma is a primary malignancy that is known to metastasize to the brain.

The first issue is to determine what kind of tumor your father has. The history

of previous melanoma is very suggestive in this case. This should be considered

in light of the characteristics of the tumor of CT scan or MRI. There may

be some other tumor types to consider, depending on your father's particular

situation. Of note, a definitive diagnosis cannot be made without looking at

the tissue at biopsy or formal surgery for removal of the tumor. At times the

physician will begin therapy, such as radiation, without having the definitive

diagnosis from a pathology slide, depending on the compelling nature of the

case.

There are a few options for patients with metastatic melanoma to the brain,

assuming this is the final diagnosis. Radiation and/or surgery have been

the mainstays of therapy in this situation. Surgery can be used depending

on the size of the tumor and the location. The risks of surgery rise if a

tumor is in or near structures that control speech or motor control, for example.

Radiation is often used whether or not surgery is done. There are a few ways

to deliver radiation to the head such as the Gamma Knife and LINAC. Again

this depends on the size, location and number of metastases in a particular

patient. There are often various trials going on for chemotherapy, however an

oncologist would be a better resource in this regard.

The big picture should be taken into account when deciding a mode of action

in this disease. Factors such as age, tumor type, location, level of function

and general medical condition should be weighed in each case to determine

the best course of action. You should discuss these issues with your surgeon

and inquire as to his or her recommendations.

Good luck.

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