An Uncommon Case of Primary Leptomeningeal Melanoma in a 66-Year-Old White Caucasian Male.

Ashutosh Mohapatra,Priyam Choudhury

doi:10.7759/cureus.10793

Abstract

Primary melanocytic tumors of the central nervous system (CNS) arise from leptomeningeal melanocytes and possess a variable degree of aggressiveness. They have been classified into melanomatosis, melanocytoma, malignant melanoma, and diffuse melanocytosis. Melanocytic lesions of the CNS include both benign (leptomeningeal melanocytosis, melanocytoma) and malignant (leptomeningeal melanomatosis, melanoma) pathologies and the extent of anatomical site involvement dictates their clinical features. Primary CNS melanoma accounts for approximately 1% of all melanoma cases with a peak incidence in the fourth decade. Though the most common location of occurrence is in the lumbar region, our patient presented with a thoracolumbar lesion. We present a case of a 66-year-old white Caucasian male who presented with complaints of headache for six months and was thoroughly evaluated leading to a rare diagnosis of primary leptomeningeal melanoma.

Highlights

Primary melanocytic tumors of the central nervous system (CNS) arise from leptomeningeal melanocytes and possess a variable degree of aggressiveness [1]
Primary leptomeningeal melanomatosis has a poor prognosis with the malignant melanocytes invading the Virchow-Robin spaces [5]
Primary CNS melanoma accounts for approximately 1% of all melanoma cases with a peak incidence in the fourth decade [8]

Summary

Introduction

Primary melanocytic tumors of the central nervous system (CNS) arise from leptomeningeal melanocytes and possess a variable degree of aggressiveness [1]. On the day of presenting to us, he complained of severe headache with blurring of vision He was evaluated by a neuro-opthalmologist and was noted to have venous engorgement and loss of venous pulsation along with haemorrhages on the optic disc. There was severe tenderness in the thoraco-lumbar region from T10 - L5 with paraesthesia He had a limping gait due to pain-visual analog scale (VAS): 6 with power grade 3. He underwent an MRI of the spine which revealed leptomeningeal enhancement from levels T10 to L4 (Figure 1). How to cite this article Mohapatra A, Choudhury P (October 04, 2020) An Uncommon Case of Primary Leptomeningeal Melanoma in a 66-Year-Old White Caucasian Male. He still occasionally gets headaches on the left side of his face from the left eye to the ear canal

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