Abstract
Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case
Highlights
Malignant melanoma is a cancer of melanocytic origin, typically cutaneous
A 65-year old Caucasian male, hypertensive, diabetic, with long-term anticoagulant and antiplatelet therapy, and a history of myocardial infarction initially presented with a hemorrhagic venous infarction of the left temporal lobe responsible for sudden motor aphasia and right-sided hemiparesis, which he recovered completely over the year
Important factors to consider in treatment selection are tumour-related, such as number, size, location of brain metastases, B-Raf (BRAF) mutation status of the melanoma, as well as patient-related, including age, overall performance status, other comorbidities and the extent of systemic metastatic disease
Summary
Melanoma is the third most frequent cause of brain metastases, after lung and breast cancer, accounting for approximately 6-11% of all metastatic brain lesions[1, 2]. A follow-up brain magnetic resonance imaging (MRI) performed six months later revealed an asymptomatic hemorrhagic venous infarction in the territory of the left vein of Labbe, as well as peculiar intra-axial and meningeal lesions of the right hemisphere (Figure 1, left). At the time he was referred to our Department and underwent a comprehensi-. The patient agreed to undergo neurosurgical treatment and one month later tumour debulking and brain biopsy were performed for histological and immunohistochemical assessment, which were consistent with cerebral metastasis from malignant pigmented melanoma (Figure 3). There were no clinically suspicious primary lesions, the patient recalled having had a thoracic lump excised some years prior, allegedly benign, but unavailable for second opinion
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