Metastatic melanoma treated with SRS for brain metastasis. Surveillance exam. There is an enhancing mass arising from the right lateral occipital bone with paraspinal soft tissue extension, measuring up to 30 mm. There also appear to be an enhancing lesions in the mandibular condyles, left larger than right. The right superior frontal gyrus enhancing lesion measures up to 4 mm, previously 7 mm. There are multiple new subcentimeter lesions, including within the right middle frontal gyrus, right superior frontal sulcus, right hippocampus, right lateral occipital lobe, right precuneus, bilateral basal ganglia, left fusiform gyrus, left orbitofrontal region, left inferior frontal sulcus, left inferior parietal lobule, left anterior cingulate gyrus, and bilateral cerebellar hemispheres. A few of the lesions display a small amount of susceptibility effect, which may represent hemorrhage. There is generally trace vasogenic edema associated with the lesions. There is scattered cerebral white matter T2 hyperintensity and encephalomalacia in the left basal ganglia. There is no evidence of 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, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a punctate nodule in the left parietal scalp.
1. Interval decrease in size of the right superior frontal gyrus, but interval appearance of numerous subcentimeter intracranial metastases.2. An enhancing mass arising from the right lateral occipital bone with paraspinal soft tissue extension, measuring up to 30 mm, likely represents a metastasis. Likewise, lesions in the mandibular condyles, left larger than right, may also represent metastases.3. Chronic lacunar infarct in the left basal ganglia, but no evidence of acute infarction.4. Nonspecific punctate nodule in the left parietal scalp.