Stage IV melanoma with two brain metastases, status post resection of a large left frontal lesion and SRS for a cerebellar lesion. Re-evaluate disease status following immunotherapy and hold due to elevated enzymes. There are postoperative findings related to left frontal craniotomy for metastasectomy. There is a subcentimeter focus of susceptibility effect without associated enhancement in the left inferior frontal gyrus resection cavity. There is more prominent enhancement on the 3D T1 sequence associated with the right lateral cerebellar hemisphere lesion, but no significant interval change in size of the lesion, measuring up to 3 mm. Previously, the 3D post-contrast sequence was obtained earlier during the scan. There is no evidence of other intracranial mass lesions. There is no evidence of intracranial hemorrhage or acute infarct. 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Post-treatment findings related to left frontal lobe metastasectomy without evidence of recurrent metastasis at this site. 2. Unchanged size, but more pronounced enhancement of the small right cerebellar metastasis, which may be due to differences in timing of the contrast material.3. No evidence of new intracranial metastases.