Clinical characteristics and outcomes of surgically treated melanoma brain metastases: a single-center case series

Abstract Background Melanoma has one of the highest propensities among solid tumors to metastasize to the brain, and melanoma brain metastases (MBM) represent a major cause of morbidity and mortality in advanced disease. Despite historically poor outcomes, the advent of immune checkpoint inhibitors and BRAF/MEK–targeted therapy has markedly improved intracranial control in selected patients. However, the optimal integration of surgery, stereotactic radiosurgery (SRS), and systemic therapy remains challenging. Methods This single-center retrospective case series included adult patients with histologically confirmed MBM who underwent neurosurgical resection as first-line therapy at the Military Medical Academy, Belgrade, between 2018 and 2023. Clinical, molecular, and treatment variables—including Eastern Cooperative Oncology Group (ECOG) performance status, BRAF mutation, lactate dehydrogenase (LDH), disease burden, corticosteroid exposure, radiotherapy, and systemic therapy—were analyzed. Overall survival (OS) was measured from MBM diagnosis to death or last follow-up. Results Seven patients (4 males, 3 females; median age 68 years) were included. Most had cutaneous melanoma (71.4%) and stage IV disease (71.4%) at MBM diagnosis. BRAF V600E mutation was detected in 42.9% of cases. Six patients (85.7%) had solitary metastases, and five (71.4%) had extracranial spread. All underwent gross total resection, with postoperative SRS in 71.4%. All received systemic therapy: anti–PD-1 monotherapy ( n = 3), nivolumab–ipilimumab ( n = 2), BRAF/MEK inhibitors ( n = 1), or sequential therapy ( n = 1). Median OS was 305 days (range 35–968). Two patients (28.6%) achieved complete remission. Conclusions Limited by the small cohort size, this case series provides descriptive, hypothesis-generating observations regarding the integration of surgery, SRS, and systemic therapy in MBM. The outcomes, while not statistically inferential, reinforce the role of surgery within multidisciplinary management and are comparable to contemporary immunotherapy-era data.