Metastatic melanoma to brain. Planning for SRS. There is interval increase in size of multiple intracranial metastases with associated vasogenic edema, including including a dominant 18 mm diameter lesion in the right occipital lobe. There is confluent T2 hyperintensity surrounding the lesions. Some of the lesions contain susceptibility effect, suggestive of prior hemorrhage. There is slight effacement of the posterior right lateral ventricle, but no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbital contents are grossly unremarkable. However, there is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is a small apical scalp lipoma. There is a right maxillary sinus retention cyst.
Pre-treatment planning MRI demonstrates overall increase in size of multiple supratentorial and infratentorial metastases and associated vasogenic edema, including a dominant 18 mm diameter lesion in the right occipital lobe, but no midline shift or herniation.