Gamma Knife Radiosurgery and Immunotherapy as Primary Treatment for a Malignant Tumor of the Cranial Base Beginning as Lentigo Maligna: A Case Report

Abstract

Metastatic spread of facial melanoma to cranial nerves causing neuropathy was described as early as 1989. 1 Jain S. Allen P.W. Desmoplastic malignant melanoma and its variants. A study of 45 cases. Am J Surg Pathol. 1989; 13: 358-373 Crossref PubMed Scopus (203) Google Scholar The trigeminal nerve is involved in several reported cases. 1 Jain S. Allen P.W. Desmoplastic malignant melanoma and its variants. A study of 45 cases. Am J Surg Pathol. 1989; 13: 358-373 Crossref PubMed Scopus (203) Google Scholar , 2 Kano H. Niranjan A. Novotny Jr., J. Bhatnagar J. Flickinger J.C. Lunsford L.D. Radiosurgery for desmoplastic melanoma of the head and neck using the Leksell Gamma Knife Perfexion technology: A case report. Stereotact Funct Neurosurg. 2009; 87: 61-65 Crossref PubMed Scopus (3) Google Scholar , 3 Majoie C.B. Hulsmans F.J. Castelijns J.A. Walter A. Bras J. Peeters F.L. Perineural tumor extension of facial malignant melanoma: CT and MRI. J Comput Assist Tomogr. 1993; 17: 973-975 Crossref PubMed Scopus (17) Google Scholar , 4 Peterson H.E. Larson E.W. Fairbanks R.K. et al. Gamma knife radiosurgery treatment for metastatic melanoma of the trigeminal nerve and brainstem: A case report and a review of the literature. Case Rep Neurol Med. 2013; 2013: 256962 PubMed Google Scholar , 5 Tritschler P. Rezazadeh Azar A. De Coene B. Maraite N. Michotte A. Trigeminal melanoma metastasis. Clin Neuroradiol. 2014; 24: 51-54 Crossref PubMed Scopus (5) Google Scholar , 6 Walters H. Lewis E. Wolper R. Yachnis A.T. Green J. Lewis S. Neurotropic melanoma of the trigeminal nerve: A case of atypical facial pain. J Oral Maxillofac Surg. 2008; 66: 547-550 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Presenting signs and symptoms may include hypoesthesia, paresthesia, and facial pain. Common magnetic resonance imaging (MRI) findings include abnormal nerve enlargement, masseter denervation atrophy, and enhancement within Meckel's cave. 7 Majoie C.B. Hulsmans F.J. Verbeeten Jr., B. et al. Trigeminal neuralgia: Comparison of two MR imaging techniques in the demonstration of neurovascular contact. Radiology. 1997; 204: 455-460 Crossref PubMed Scopus (79) Google Scholar , 8 Majoie C.B. Hulsmans F.J. Verbeeten Jr., B. et al. Perineural tumor extension along the trigeminal nerve: Magnetic resonance imaging findings. Eur J Radiol. 1997; 24: 191-205 Abstract Full Text PDF PubMed Scopus (40) Google Scholar It is difficult to diagnose metastatic disease without histologic confirmation, but metastases should be highly considered in a patient presenting with a cranial neuropathy, history of a facial lesion, and remarkable image findings.