Progressive metastatic melanoma after Ipilimumab. The clivus appears heterogeneous and there is an enhancing lesion within in the partially imaged right aspect of C1. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nonspecific non-enhancing subcentimeter nodule in the posterior upper neck subcutaneous tissues. There is scattered paranasal sinus mucosal thickening.
1. No evidence of intracranial metastases or hypophysitis.2. Findings suggestive of bone metastases involving the upper cervical spine and perhaps the skull base. Dedicated cervical spine imaging may be useful for further evaluation.