Brain metastases are a common complication of melanoma. Melanoma is a type of skin cancer that starts in melanocytes — the cells in skin that make a brown or tan pigment.

When melanoma spreads to distant parts of the body, such as the brain, it’s called advanced melanoma, metastatic melanoma, or stage 4 melanoma. When melanoma spreads to the brain, it’s called metastatic brain cancer or secondary brain tumors. Melanoma is a common cause of metastatic brain cancer — about 10 percent of all people who develop metastatic brain cancer have melanoma.

If you or a loved one has been diagnosed with melanoma, you may be concerned about melanoma spreading to the brain. Continue reading to learn more about when melanoma spreads to the brain, how fast brain tumors can grow, and your treatment options.

How Does Melanoma Spread to the Brain?

Melanoma is more dangerous than other types of skin cancer because it’s more likely to spread to other parts of your body. Melanoma starts when melanocytes in your skin begin to grow out of control. Melanoma cancer cells have genetic changes that allow some cancer cells to break away and spread to other parts of the body through the bloodstream or lymph nodes. These genetic changes can also help cancer cells hide from your body’s immune system.

The brain is the third most common site for melanoma metastasis. Melanoma spreads to the brain in about half of people who have melanoma on the skin. Melanoma also often spreads to the lungs, liver, or spleen.

It may be surprising to learn that skin cancer can easily spread to the brain, but brain cells and melanocytes come from the same part of the body in early human development. This means that brain cells may be a natural environment for growth of melanoma cancer cells.

About 80 percent of melanoma brain metastases occur in the supratentorial (upper) area of the brain, according to Wolters Kluwer UpToDate. Less commonly, melanoma brain metastases can develop in the infratentorial area (lower back part) or the brainstem.

What Are the Risk Factors for Melanoma Brain Metastases?

Your risk of melanoma brain metastasis increases the longer you have the disease. People initially diagnosed with stage 1 or stage 2 melanoma — melanoma that's limited to the skin and local lymph nodes — are less likely to develop brain metastases over time.

Most people with brain metastasis also have metastasis in other parts of the body. It’s expected that about 60 percent of people with stage 4 melanoma will develop brain tumors at some point. Metastasis is usually found in another part of the body before it’s found in the brain. About 1 out of 3 people with metastatic melanoma are found to also have brain metastasis when they’re diagnosed.

Risk factors for melanoma brain metastasis include the following:

• Male sex
• Age over 60 years
• Mucosal melanoma (melanoma inside the nose, mouth, throat, or genital area)
• Melanoma on the trunk, head, neck, or scalp
• A primary tumor that is invasive (deep) or ulcerated (has broken the skin)
• Higher-than-normal levels of lactate dehydrogenase (LDH), a substance in your blood that can be a sign melanoma has spread
• Acral lentiginous melanoma (a rare subtype that affects palms, soles, and nails) or nodular melanoma, which resembles blood blisters
• Melanoma that has spread to more than three regional lymph nodes
• Melanoma that has spread to internal organs

NRAS or BRAF gene mutations (changes) in melanoma cancer cells may also make melanoma more likely to spread to the brain. NRAS and BRAF genes help regulate cell growth. Mutations in these genes can cause cells to grow out of control. To check for these mutations, your cancer care team can perform molecular testing on a tissue sample of your tumor (a biopsy).

How Does Brain Metastasis Affect Your Outlook?

Although early-stage melanoma typically has a good prognosis (outlook), melanoma brain metastasis often has a poor prognosis. People diagnosed with early-stage, local melanoma have more than a 99 percent chance of living at least five years compared with the general population. This is referred to as the five-year relative survival rate. The five-year relative survival rate for people diagnosed with melanoma that has spread to distant parts of the body drops to 35 percent.

The length of time that half of people diagnosed with melanoma brain metastases are still alive (called the median overall survival) used to be four to five months. However, treatment advances have improved survival, and the median overall survival is about 11 months with some treatments.

Factors associated with a better prognosis include the following:

• Age less than 60 years
• No more than two brain tumors
• No metastases in other parts of the body
• Normal blood levels of LDH
• Ability to care for yourself (known as performance status)

How Fast Do Brain Metastases Grow?

Brain metastases have a reputation for being very aggressive types of cancers that can grow in a short period of time. A 2024 study of 109 people with large brain metastases found that in the time between diagnosis and treatment, half of the participants’ 126 total brain tumors grew at least 2.6 percent bigger. Seventy percent of the tumors were slow-growing and grew less than 5 percent, and 30 percent grew rapidly and were at least 5 percent larger.

Although 2.6 percent may not seem like a big number, even a small increase in the size of a tumor can have a big impact on symptoms.

What Are the Symptoms of Brain Metastasis?

Not everyone with brain metastasis has symptoms. Between 55 percent and 80 percent of people with brain metastases have no symptoms. This can be dangerous because once symptoms are noticed, people often have multiple brain tumors.

When people do have symptoms, common symptoms of melanoma brain metastases may include:

• Headache
• Problems with vision
• Seizures
• Paralysis (inability to move) in part of the body
• Slurred speech
• Nausea or vomiting
• Weakness
• Fatigue (extreme tiredness)
• Spontaneous brain hemorrhage (bleeding)

Talk to your cancer care team right away if you notice any unusual symptoms.

How Are Brain Tumors Diagnosed?

If your cancer care team suspects that melanoma has spread to your brain, you may undergo several tests, including:

• Neurological exam — Checks vision, hearing, balance, strength, reflexes, and more
• Imaging tests — Includes MRI or CT scan
• Biopsy — Involves removing a sample of tumor tissue (via surgery or using a needle) for examination under a microscope

How Are Brain Tumors Treated?

There’s no cure for melanoma brain metastasis, but treatments can help control your disease. Options include:

• Surgery — May be be a good choice for people with two or fewer metastases and melanoma that’s otherwise controlled
• Radiation therapy, such as stereotactic radiosurgery (SRS) or gamma knife — Targets specific areas of the brain
• Whole brain radiation treatment — Treats multiple brain metastases or tumors that are too small to see on imaging tests

Treating brain tumors with medication can be difficult because the brain’s blood–brain barrier protects it from potentially harmful substances. This means that some medications may have difficulty getting to the brain tumor from the bloodstream. Medications that may be used to treat brain tumors include:

• Steroids — May help improve symptoms by decreasing brain swelling
• Immunotherapy — Helps your immune system fight brain tumors and includes medications such as ipilimumab (Yervoy), nivolumab (Opdivo), nivolumab and relatlimab-rmbw (Opdualag), and pembrolizumab (Keytruda)
• Targeted therapy — Helps slow tumor growth in people with BRAF mutations and includes dabrafenib (Tafinlar), trametinib (Mekinist), vemurafenib (Zelboraf), cobimetinib (Cotellic), encorafenib (Braftovi), and binimetinib (Mektovi)
• Chemotherapy — Can penetrate the blood–brain barrier and includes temozolomide (Temodar)

Read more about specific medications in this list of treatments for melanoma.

A palliative care specialist can help treat the symptoms of metastatic brain tumors, side effects from treatment, and emotional difficulties for you and your loved ones. Talk to your cancer care team about the best treatment plan for you.

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with melanoma.

Have you been diagnosed with melanoma brain metastasis? Share your experience in the comments below, or start a conversation by posting on your Activities page.