Fotemustine is primarily used in the treatment of malignant melanoma, particularly in cases where the cancer has spread to the brain. It is administered intravenously and works by alkylating DNA, which inhibits the growth of cancer cells. The drug is especially valued for its ability to cross the blood-brain barrier, making it effective against cerebral metastases. In clinical settings, fotemustine is often considered when other treatments have failed or are not suitable. It is typically given in a series of doses, with careful monitoring for side effects such as myelosuppression. The drug has shown promise in improving survival rates and controlling disease progression in advanced melanoma patients.