The incidence of cutaneous melanoma is increasing, and 10-20% of these melanomas are located in the head and neck region. The incidence of brain metastases, risk factors and outcome were analysed for melanomas originating in the head and neck region. During the period 1965-2000, 324 patients [152 females (47%), 172 males (53%)] were treated for cutaneous melanoma of the head and neck. The patients were staged according to the 2002 American Joint Committee on Cancer (AJCC) melanoma staging system. A matched control analysis was performed in order to identify the risk factors for the occurrence of brain metastases. The analysis was performed using cross-tabulations, chi-squared test and the logistic regression method. Twenty six (8%) head and neck patients, compared with 5.2% of extremity/truncal patients, developed brain metastases (confidence interval, 0.058-0.108; P<0.05). The 26 head and neck patients (four Stage I, 10 Stage II and 12 Stage III) had a median age of 46 years (range, 16-79 years) and developed brain metastases after a median follow-up of 24 months (range, 4-75 months). The median Breslow thickness was 3.3 mm (range, 0.7-12 mm). The patients were treated with steroids, surgery, radiation, chemotherapy, or a combination of these. The median survival after the development of brain metastases was 2.4 months (range, 0.2-64.3 months), with a 1-year overall survival of 15%. Risk factors identified for the development of brain metastases from head and neck melanoma were a younger age, male gender, Breslow thickness greater than 4 mm and increased mitotic rate. The incidence of brain metastases is significantly higher in patients with cutaneous melanoma of the head and neck (8%) compared with those with extremity/truncal melanoma (5.2%). The prognosis is still extremely poor with current therapies.

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Nowadays leakage from isolated perfusions into the systemic circulation is further minimized compared with the days when melphalan was the sole drug used. Increased awareness about TNFalpha leakage, continuous external monitoring with 131I-albumin as the main isotope, flow rate regulation in the perfusion circuit, and regulation of the patient's systemic blood pressure have all been major contributors to this improvement.