Case-Based Modules > Case 3 > Stage 3

Sorry! It's true that her overall prognosis is poor given the presence of leptomeningeal involvement. With the refractoriness of her melanoma, it's true that you could decide that no surgery should be offered. That's not unreasonable. If she's had nothing but a downward trajectory over the past month, that's even more reason to not offer any intervention. However, note that her neurologic decline was rapid and everyone acted quickly. Her left pupil has only just become blown. For the purpose of education for this case, though, let's say that a procedure in general hasn't been ruled out, and that you're willing to offer a palliative intervention. (Or at least, something like a decompressive hemicraniectomy can totally be left off the table.)

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