Abstract
BackgroundBrain metastasis is a common endpoint in patients suffering from malignant melanoma. However, little is known about factors that predispose to brain metastases.ObjectiveWe performed a retrospective clinical and pathological investigation of melanoma patients with brain metastases in order to better characterise this patient population.Methods193 melanoma patients with brain metastasis histologically diagnosed between 1990 and 2015 at the University Hospital Zurich were retrospectively identified and further specified for sex, age at diagnosis and detection of brain metastasis, and localisation. In addition, data were extracted regarding the subtype of primary melanoma, Breslow tumour thickness, Clark Level, mutation status, extent of metastatic spread and history of a second melanoma.ResultsWe found a significant male predominance (n = 126/193; 65%; p < 0.001). Breslow tumour thickness showed a wide range from 0.2 to 12.0 mm (n = 99; median 2.3 mm). 14 of 101 melanomas (14%) were classified as T1, thereof 11 (79%) were found in men. In 32 of 193 patients (17%), the primary melanoma was unknown.ConclusionsOf special interest in our series is the high incidence of male predominance (79%) in cases of thin metastasing melanoma (14%), implicating genetic or epigenetic (hormonal) gender differences underlying tumour progression. Additionally, the high percentage of unknown primary melanoma (17%), at least partly representing completely regressed melanomas, indicates the importance of immune surveillance in melanoma progression.
Highlights
The development of brain metastases, reported to occur in up to 25% of patients with cancer, is a common and devastating complication of many systemic malignancies [1]
Brain metastasis is a common endpoint in patients suffering from malignant melanoma
Of special interest in our series is the high incidence of male predominance (79%) in cases of thin metastasing melanoma (14%), implicating genetic or epigenetic gender
Summary
The development of brain metastases, reported to occur in up to 25% of patients with cancer, is a common and devastating complication of many systemic malignancies [1]. The reported incidence of cerebral metastases is variable and dependent on whether the source is clinical or autopsy data, the patient population, and other factors. An autopsy study reported melanoma as the most commonly encountered source of brain metastasis. The incidence of melanoma brain metastasis was recorded as 91%, followed by breast (37%) and lung (34%) cancer [3]. Not all cancers seem to share the same propensity to cross the blood-brain barrier. MicroRNA-containing vesicles capable of destroying the blood-brain barrier have recently been identified as a mechanism in breast cancer [5]. Brain metastasis is a common endpoint in patients suffering from malignant melanoma. Little is known about factors that predispose to brain metastases
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