Neurooncological Challenges in Relapsing Intracranial Melanoma Metastases: A Case Report

Abstract

Introduction: Treatment of melanoma brain metastases (MBM) is a complex interdisciplinary challenge. Relapsing MBMs pose an extra challenge due to limited therapeutic options and higher complication rate. Multiple surgical interventions and radiation can be indicated in the case of intracranial relapse with extracranial disease control under oncological therapy e.g., immunotherapy. Case Presentation: Here, we report on a 37-year-old female patient with stage IV metastatic melanoma, who underwent six neurosurgical procedures, including five tumor resections, and three courses of different irradiation protocols in 26 months, all while receiving multiple regimens of immunotherapy. Throughout the different therapies, the patient showed varying neurological deficits, including facial nerve palsy, hemiparesis and reduction of cognitive function. The patient died due to symptoms related to leptomeningeal spread of the tumor. Conclusion: With this case, we want to share our experience with multiple neurosurgical interventions and repeated brain irradiation procedures in a patient with relapsing MBM. Neurosurgical interventions contributed to symptom relief, saved steroids and potentially prolonged survival. Therefore, based on the events of this case, repeated surgery could be considered for progressive brain metastases.