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Spread of Melanoma to the Brain

Patient Guide

Spread of Melanoma to the Brain

Most patients diagnosed with a melanoma are cured by their initial surgery and have no further problems from their melanoma.

Some patients with Stage 2 or 3 melanoma, and almost all patients with Stage 4 melanoma, are offered surveillance scans to monitor for any early evidence of spread or growth of their melanoma. These scans may include imaging of the brain. This is because of the small risk that melanoma can spread to the brain.

Routine surveillance scans of your brain have some disadvantages. These include the additional stress of undergoing the scan (particularly if it is an MRI scan which some people can find noisy and claustrophobic), the additional radiation exposure (if it is a CT scan) and possible anxiety whilst you wait for scan results. There is also the small risk of ‘red herrings’, which are abnormalities found on a scan which later turn out to be unrelated to your melanoma.

The advantages of routine surveillance scans of your brain are that they increase the likelihood of your medical team identifying spread of the melanoma to the brain at a very early stage. This may increase the options for treatment, which can include surgery, specialised radiotherapy, immunotherapy, sometimes a combination of these different approaches or a clinical trial.

Your medical team will be able to advise whether the advantages of routine scans of your brain outweigh the disadvantages, for your particular situation.

If your melanoma team do find signs that your melanoma may have spread to the brain, they will discuss what this means for you. They are likely to involve other specialists, who may include neuro-radiologists (doctors who specialise in looking at brain scans), neuro-surgeons (doctors who perform brain surgery), neuro-oncologists (radiotherapy doctors who specialise in cancer in the brain) and palliative care doctors (doctors who specialise in symptom control). Gathering all these specialist opinions can take time, sometimes a few weeks, and this will be a stressful time whilst you wait to hear what is advised. The involvement of different expert teams is important to ensure that all treatment options are carefully considered. Your Clinical Nurse Specialist (CNS) can support you during this time.

Treatment of Brain Metastases

The treatment of melanoma that has spread to the brain (brain metastases) has changed significantly over the last few years. It can be tempting to look online to learn more about melanoma brain metastases. However, some of this information will be  out-of-date and may not be relevant to your particular situation and this can be upsetting. Recent advances in surveillance scans, surgical and radiotherapy techniques, as well as new drug treatments, have greatly improved the care of patients whose melanoma has spread to the brain. For many patients, although unfortunately still not all, there is the prospect of long-term disease control and some patients never develop symptoms from their brain metastases. Your medical team will talk to you about how your treatment is going and the chance that treatment will control the melanoma in your brain.

How Brain Metastases may Affect your Lifestyle?

Any new abnormality in the brain, even a tiny tumour, can in theory increase the chance of something unexpected happening to you, such as a blackout or seizure. It is important to remember that these sort of worrying incidents do not happen to most people, particularly if the tumour in your brain was an incidental finding on a surveillance scan. However, unfortunately, you may not get any warning if a blackout or seizure is going to happen. This is therefore potentially very dangerous if it were to happen whilst you were driving, travelling, at work or doing certain sports. It is a very personal situation and you would need to consider your lifestyle holistically. Please discuss this with your medical team or clinical nurse specialist if this worries you.

Driving and the DVLA

The DVLA (Driver and Vehicle Licencing Agency) makes the rules for who is permitted to drive on UK roads. Anybody diagnosed with new spread of melanoma to the brain must stop driving immediately and has a duty to inform the DVLA of this new information. This is to protect you, as the driver, and also other road users. Therefore, the DVLA require everyone with new brain metastases to stop driving. This information also affects your motor insurance, so it is also important to contact your insurance company to update the policy, regardless of whether you’re driving or not.

Being asked to stop driving can be very upsetting, particularly if you are feeling completely well and the surveillance scan has picked up something that is very small and causing you no problems. For some patients, not being able to drive is the biggest day-to-day reminder of their melanoma diagnosis and it can be very difficult having to rely on others. Your Clinical Nurse Specialist is available to support you, and your medical team will be happy to keep the DVLA updated about your condition, when the DVLA contact them. Once the DVLA are satisfied that your condition is stable (currently for two years) they usually agree that you can begin driving again.

Additional Resources 

Professor Paul Nathan talks Brain Mets at the UK Melanoma Patient Conference 2022