# Two Cases of Malignant Melanoma with Long-term Survival after the Appearance of Brain Metastases

## TL;DR

Two patients with malignant melanoma and brain metastases survived for over five years using a combination of radiotherapy, chemotherapy, and BRAF inhibitors.

## Contribution

Reports two rare cases of long-term survival in malignant melanoma patients with brain metastases using combined treatment approaches.

## Key findings

- Combination of BRAF inhibitors, immune checkpoint inhibitors, and stereotactic radiotherapy led to survival exceeding five and six years.
- Both patients had BRAF gene mutations in their primary tumors.
- Long-term survival in brain metastases from melanoma is rare but achievable with modern therapies.

## Abstract

Brain metastases from malignant tumors are generally known to have a poor prognosis. One of the major reasons for this is the lack of efficacy of anti-tumor drugs compared to other organs. One of the major reasons for this is the lack of efficacy of anti-tumor drugs compared to other organs. Malignant melanoma is a highly malignant tumor that occurs mainly in the skin and is relatively prone to brain metastasis. In this case report, we report two cases of malignant melanoma with brain metastases that were treated with a combination of radiotherapy and chemotherapy and had long-term survival. Case 1 was a 51-year-old Japanese man with primary melanoma of the chest; the pathological staging was pT4aN1aM0, stage IIIC. He developed multiple brain metastases two years and three months after the initial resection. Case 2 was a 23-year-old Japanese woman with primary melanoma of the upper extremities; the pathological staging was pT1bN1aM0, stage IIIA. She developed brain metastases one year and nine months after the initial resection. Both patients had positive BRAF gene mutations in their primary tumors. The combination of BRAF inhibitors, immune checkpoint inhibitors, and stereotactic radiotherapy resulted in long-term survival of more than 5 years for Case 1 and more than 6 years for Case 2. With advances in chemotherapy and radiotherapy, the prognosis for patients with brain metastases, not only malignant melanoma, is expected to improve further in the future. Although rare, malignant melanoma is known to occur in various organs other than the skin. We report this case because we believe that our case report will be of interest to physicians who treat the above organs.