When melanoma has spread to the brain but the patient remains asymptomatic, a specific evidence-based pathway applies — one that differs from symptomatic CNS disease and integrates both systemic and local treatment considerations from the outset.
This protocol covers patients with melanoma who have asymptomatic brain metastases (MBMs). The absence of neurological symptoms in this group makes early, proactive intervention feasible, and the choice of upfront strategy carries significant prognostic weight.
Upfront systemic immunotherapy combination is the preferred strategy for this population. For patients who are not suitable for immunotherapy and whose tumour carries a specific molecular alteration, targeted therapy may be an alternative. Stereotactic radiosurgery (SRS) is also evaluated as part of the management plan, with timing considerations shaping the optimal approach — access the full protocol for the complete sequenced algorithm.