Spinal Melanoma Research Articles

SPIN-01 PRIMARY MALIGNANT MELANOMA, AN ATYPICAL PRESENTATION IN THE CERVICAL SPINE: A CASE REPORT

Abstract BACKGROUND Few studies have documented the occurrence of melanoma in the cervical spine. Of all malignant melanoma cases, 1% are primary melanoma of the central nervous system, which makes it extremely uncommon and nonspecific. We aim to report a case of the uncommon presentation of primary melanoma in the cervical spine. Case presentation: The patient was a 59-year-old Muganda male who presented with a 2-year history of anterior neck swelling as well as severe pain and a tingling sensation in the left shoulder and arm, which worsened in the recent 6 months. He developed weakness and paresthesia in the upper left arm and progressive gait disturbance of the left leg. A physical examination revealed masses in the left cervical and right submandibular region. Additionally, the upper and lower left extremities revealed hemiparesis and hemihypoesthesia. A magnetic resonance imaging scan showed a hyperintense lesion on TIWI and another hypointense lesion on T2WI, originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed the tumor to be malignant melanoma. The patient died within 1 month after the diagnosis and surgery. CONCLUSION This case is presented to highlight the significance and challenges associated with making a pre- and postoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1-weighted images and hypointensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.

Extradural spinal melanoma: is it primary or metastatic? A case report with a brief review of literature

Melanocytic lesions involving the central nervous system are extremely rare and pose a diagnostic challenge owing melanoma being the third most common malignancy metastasizing to the spine. Morphology and immunohistochemistry are identical in both primary and secondary cases, and hence may not help in rendering a final diagnosis. Molecular alterations involving melanomas of the spine and melanomas elsewhere are distinct and help establish the appropriate diagnosis. We report an interesting case where molecular profiling of the tumor tissue helped render the final diagnosis.

Primary malignant melanoma, an atypical presentation in the cervical spine: a case report

BackgroundFew studies have documented the occurrence of melanoma in the cervical spine. Of all malignant melanoma cases, 1% are primary melanoma of the central nervous system, which makes it extremely uncommon and nonspecific. We aim to report a case of the uncommon presentation of primary melanoma in the cervical spine.Case presentationThe patient was a 59-year-old Muganda male who presented with a 2-year history of anterior neck swelling as well as severe pain and a tingling sensation in the left shoulder and arm, which worsened in the recent 6 months. He developed weakness and paresthesia in the upper left arm and progressive gait disturbance of the left leg. A physical examination revealed masses in the left cervical and right submandibular region. Additionally, the upper and lower left extremities revealed hemiparesis and hemihypoesthesia. A magnetic resonance imaging scan showed a hyperintense lesion on TIWI and another hypointense lesion on T2WI, originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed the tumor to be malignant melanoma. The patient died within 1 month after the diagnosis and surgery.ConclusionThis case is presented to highlight the significance and challenges associated with making a pre- and postoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1-weighted images and hypointensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.

SURG-46. PRIMARY MALIGNANT MELANOMA, AN ATYPICAL PRESENTATION IN THE CERVICAL SPINE

Abstract Few studies have documented the occurrences of melanomas in the cervical spine. one percent of all malignant melanoma cases are primary melanoma of the central nervous system, which is extremely uncommon and nonspecific. We aimed to report a case of uncommon presentation of primary melanoma in the cervical spine. This a 59-year-old, male who presented with a 2-year history of anterior neck swelling, severe pain and tingling sensation in the left shoulder and arm which worsened in the previous 6 months. He developed weakness and paresthesia in the left upper arm and progressive gait disturbance of the left lower limb. Physical examination revealed masses in the left cervical and right submandibular region. There was left upper and lower extremities hemiparesis and hemi hypoesthesia. MRI showed hyperintense lesion on T1WI and hypointense on T2WI originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed malignant melanoma. This case is presented in order to highlight the significance of and challenges associated with making a preoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1 weighted images and hypo intensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.

Primary spinal melanoma: A radiological diagnostic dilemma confirmed by histopathology

Primary malignant melanoma of central nervous system accounts for approximately 1% of all melanomas. Primary spinal melanomas are even more unusual. The clinico-radiological features of primary spinal melanoma are complex and non-specific, resulting in a high misdiagnosis rate. Here, primary cervico-thoracic spinal melanoma is presented in a 53-year-old woman which mimicked a hematoma on magnetic resonance imaging and an arteriovenous malformation intraoperatively. Histopathology and immunohistochemistry confirmed the diagnosis of malignant melanoma.

Role of mTOR and VEGFR Inhibition in Prevention of Metastatic Tumor Growth in the Spine.

Objective: Spinal metastatic disease remains a major problem of oncological diseases. Patients affected may suffer pain, spinal instability, and severe neurological deficits. Today, palliative surgery and radiotherapy are the mainstays of therapy. In contrast, preventive treatment strategies or treatment concepts for an early stage are lacking. Here, we have used a syngeneic, experimental spine metastases model in the mouse to test the efficacy of mTOR inhibition and anti-angiogenesis on the formation and progression of spinal melanoma metastases.Methods: We used our previously established syngeneic spinal metastases mouse model by injecting luciferin-transfected B16 melanoma cells into the common carotid artery. Following injection, mice were treated with everolimus, an inhibitor of the mammalian target of rapamycin (mTOR) complex, axitinib, a tyrosine kinase inhibitor, that blocks vascular endothelial growth factor receptors (VEGFR) 1-3, as well as placebo. Animals were followed-up daily by neurological assessment and by repeat in vivo bioluminescence imaging. With occurrence of neurological deficits, a spinal MRI was performed, and mice were sacrificed. The whole spine was dissected free and analyzed by immunohistochemical techniques.Results: Overall survival was 23 days in the control group, significantly prolonged to 30 days (p = 0.04) in the everolimus group, and to 28 days (p = 0.04) in the axitinib group. While 78% of mice in the placebo group developed symptomatic metastatic epidural spinal cord compression, only 50% did so in the treatment groups. The mean time to manifestation of paralysis was 22 days in the control group, 26 days (p = 0.10) in the everolimus group, and 27 days (p = 0.06) in the axitinib group. Screening for spinal metastases by bioluminescence imaging on two different time points showed a decrease in metastatic tumor formation in the treatment groups compared to the controls. Immunohistochemical analysis confirmed the bioactivity of the two compounds: The Ki67 proliferation labeling index was reduced in the everolimus group and numbers of CD31 positive endothelial cells were reduced in the axitinib group.Conclusion: Both, the mTOR inhibitor everolimus as well as antiangiogenetic effects by the VEGFR inhibitor axitinib showed potential to prevent and retard formation of symptomatic spinal metastases. However, the therapeutic efficacy was only mild in this experimental model.

Primary Spinal Cord Melanoma – An Uncommon Entity

Primary Spinal Cord Melanoma – An Uncommon Entity

Prognostic factors of patients with spinal malignant melanoma after surgical intervention: a case series of 21 patients and literature review.

Spinal malignant melanoma (SMM) is a rare type of tumor that can cause nerve roots or spinal cord compression. Patients often suffer from fierce pain and paralyzation. And the estimated survival time were less than 6 months. Surgical interventions to remove the tumor and decompress the nearby nerve roots and spinal cord are effective management. Unfortunately, there lack a thorough and persuasive surgical guideline that specifically aims for this disease. It is necessary to obtain some clinical prognostic factors that predict the recurrence rate and overall survival (OS) of patients with SMM who underwent surgical interventions. 21 patients with SMM who underwent surgical intervention were retrospectively reviewed. Related patients factors, treatment factors and tumor factors were acquired and subjected into survive analyses using Kaplan-Meier method and the log-rank test. Further Cox proportional hazards model was used to identify independent prognostic factors. Literature regarding surgical interventions on SMM patients were reviewed and summarized as well. Surgical approach total en-bloc spondylectomy (TES/Piecemeal) (p = 0.015, B 0.029, 95%CI 0.002-0.508), preoperative Frankel grade (A-C/D-E) (p = 0.021, B 15.041, 95%CI 1.492-151.669) and tumor metastases (Yes/No) (p = 0.013, B 16.667, 95%CI 1.805-153.897) are independent prognostic factors for recurrence free survival (RFS). Preoperative Frankel grade (A-C/D-E) (p = 0.031, B 10.676, 95%CI 1.241-91.877) is independent prognostic factors for OS. 12 literatures have been reviewed, including 11 case reports and one retrospective study. Surgical interventions for patients with SMM are beneficial. Surgical approach (TES/piecemeal), tumor origin (primary/metastasis) and preoperative Frankel grade (A-C/D-E) are independent risk factors in predicting RFS. Preoperative Frankel grade (A-C/D-E) is independent prognostic factor in predicting OS.

A rare case of primary intradural spinal melanoma presenting with a cauda equina syndrome

A rare case of primary intradural spinal melanoma presenting with a cauda equina syndrome

Primary cervical spine melanoma

Primary spinal melanoma is too rare to have any systemic statistical data on the epidemiology of this disease. We report a 58-year-old woman presented with spastic gait for 10 days, preceded by chronic pain at her left anterior chest that progressively spread to her neck, left shoulder, and arm in half a year. Cervical magnetic resonance imaging (MRI) displayed a well-enhancing focal intraspinal extramedullary tumor at C6/7 level. After surgical resection of the tumor and thorough studies to exclude extraspinal melanoma, the primary spinal melanoma is diagnosed. Postoperative MRI did not disclose any evidence of recurrence at 4 and 21 months later. We present the clinical, radiological, and pathological features of a patient with a primary cervical extramedullary spinal melanoma.

Clinical features and long-term outcomes of primary spinal malignant melanoma: a single center experience

Primary malignant melanomas are very rare tumors in the spinal canal. In this study, the authors review their experience in a series of seven patients with histologically proven primary spinal malignant melanoma (PSMM) and discuss the clinical features, treatment strategy, and long-term outcomes. Clinical data of seven patients with PSMM treated at a single institution were retrospectively analyzed. There were three male and four female patients, with a mean age of 44 years. The mean duration of illness was 5.4 months. The tumors showed hyperintensity in six cases on T1-weighted image (WI) and isointensity or hypointensity in five cases on T2WI. Gross total resection (GTR) of the tumor was achieved in two cases, and subtotal resection (STR) was achieved in five cases. Four STR patients underwent postoperative local radiation therapy. Postoperative MRI results showed no tumor recurrence in all four female patients after an average follow-up period of 64.5 months. Three male patients had tumor recurrence and dissemination after postoperative 14.7 months (8-24 months), and all died 16.3 months (10-25 months) after initial diagnosis. PSMM should be considered in the differential diagnosis of a middle-aged patient with spinal lesion if the tumor shows hyperintensity on T1WI and hypointensity or isointensity on T2WI on MRI. STR followed by radiotherapy is not excessively associated with deterioration of the final outcome compared to GTR. Our study suggests that PSMM might have female predominance in favorable outcome. Surgical resection followed by adjuvant radiotherapy and regular follow-up are recommended.

Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine.

Background Context. Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up. Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation. Study Design. Case report. Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine. Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms. Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.

Manifestations of spinal melanoma metastases: case presentation and literature review

Manifestations of spinal melanoma metastases: case presentation and literature review

Primary spinal melanoma of extramedullary origin: a report of three cases and systematic review of the literature.

A review of the literature and three case reports. Primary spinal melanoma (PSM) of extramedullary origin is a rare malignant condition with limited current literature in regards to its clinical course, magnetic resonance imaging (MRI) findings, treatment strategies and prognosis. We reported here three cases of PSM of extramedullary origin. China, Guangzhou. We report three cases of PSM of extramedullary origin. The clinical and radiological findings of these cases were retrospectively analyzed. The three cases were all of males aged 39, 47 and 76 years, respectively. The duration of their symptoms was 3 weeks, 2 months and 11 months respectively. The extramedullary tumors were all well-defined solitary tumors and were located at C4-5, L2-3 and T9-10, respectively. In one case, involvement of the intervertebral foramen was found. Preoperative MRI showed hyperintense T1W signals and hypointense T2W signals in all three cases and all tumors were clinically misdiagnosed as schwannomas. The patients received total or subtotal resection surgery without radiotherapy or chemotherapy. Patients were alive at 18 months, 27 months and 36 months postoperative follow-up, respectively. PSM of extramedullary origin is a rare malignant tumor that shows characteristic findings on MRI. Surgical resection is the preferred treatment strategy.

Stereotactic radiosurgery and immunotherapy for metastatic spinal melanoma.

The management of metastatic spinal melanoma involves maximizing local control, preventing recurrence, and minimizing treatment-associated toxicity and spinal cord damage. Additionally, therapeutic measures should promote mechanical stability, facilitate rehabilitation, and promote quality of life. These objectives prove difficult to achieve given melanoma's elusive nature, radioresistant and chemoresistant histology, vascular character, and tendency for rapid and early metastasis. Different therapeutic modalities exist for metastatic spinal melanoma treatment, including resection (definitive, debulking, or stabilization procedures), stereotactic radiosurgery, and immunotherapeutic techniques, but no single treatment modality has proven fully effective. The authors present a conceptual overview and critique of these techniques, assessing their effectiveness, separately and combined, in the treatment of metastatic spinal melanoma. They provide an up-to-date guide for multidisciplinary treatment strategies. Protocols that incorporate specific, goal-defined surgery, immunotherapy, and stereotactic radiosurgery would be beneficial in efforts to maximize local control and minimize toxicity.

Primary extramedullary spinal melanoma mimicking spinal meningioma: A case report and literature review.

Primary spinal melanoma is a rare lesion, which occurs throughout the cranial and spinal regions, however, is primarily observed in the middle or lower thoracic spine. The clinical features of primary spinal melanoma are complex and unspecific, resulting in a high misdiagnosis rate. In the present case report, a rare case of spinal melanoma exhibiting the dural tail sign and mimicking spinal meningioma is reported. The initial diagnosis, using magnetic resonance imaging (MRI), was unclear. Thus, melanin-containing tumors and spinal meningioma should have been considered in the differential diagnosis. The tumor was completely resected using a standard posterior midline approach, which was followed by chemotherapy. Subsequent to the surgery, the patient was discharged with improved motor capacity and a follow-up MRI scan showed no recurrence after six months. The present study demonstrates that it is critical for neurosurgeons to focus on increasing the accuracy of initial diagnoses in order to make informed decisions regarding the requirement for surgical resection. The present case report presents the clinical, radiological and pathological features of primary extramedullary spinal melanoma mimicking spinal meningioma to emphasize the importance of early identification and diagnosis.

Primary Cervical Intramedullary Spinal Cord Melanoma

Primary Cervical Intramedullary Spinal Cord Melanoma

Management preferences and prognosis for primary intracranial melanocytic neoplasms

Background: Contrary to relatively frequent metastatic melanoma, primary melanocytic CNS neoplasms are rare, coming up from melanocytes situated in the leptomeninges. These lesions incorporate diffuse meningeal melanomatosis, melanin-pigmented meningioma, well-differentiated benign melanocytoma, and primary malignant intracranial and/or spinal melanoma.

Primary Spinal Malignant Melanoma of Spinal Cord and Conus Medullaris

Primary Spinal Malignant Melanoma of Spinal Cord and Conus Medullaris

Primary Melanoma of the Cervical Spine with Cerebral Metastases: Case Report and Review of the Literature

Primary spinal melanoma is a very rare condition: to date < 60 cases have been reported in the literature. A 48-year-old man presented with a 6-month history of upper- and lower-extremity numbness. Spinal magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C2-C6 level. This was confirmed as a melanoma by immunohistochemistry. Cerebral MRI showed multiple lesions with the same signal characteristics as those seen in the spinal lesion on MRI. Complete skin, mucosal and retinal examination failed to show any primary lesion, therefore a diagnosis of primary cervical melanoma with brain metastases was made. To our knowledge this is the first report of a primary melanoma of the cervical spine with cerebral metastases at the time of diagnosis. This article presents pertinent reported literature and discusses the aetiology, diagnosis, treatment and prognosis of this unusual condition.