Intramedullary primary spinal cord melanoma: illustrative case

Abstract

BACKGROUND

Intramedullary primary spinal melanoma (IPSM) is a rare tumor, with limited reports on its clinical presentation, radiographic features, histopathological and genetic factors, diagnosis, and management.

OBSERVATIONS

A 49-year-old male presented with a 9-month history of intermittent, progressive left upper-extremity radiculopathy and left-sided numbness. Magnetic resonance imaging revealed an intramedullary tumor at the C6–T1 vertebral levels. Intraoperatively, upon opening the dura, the tumor was noted to be dark in appearance. Dorsal column mapping allowed for safe myelotomies above and below the tumor bulk, and a gross-total resection was achieved. The patient awoke with mild decreased lower-extremity sensation and proprioception but full motor strength. Surgical pathology was consistent with melanoma. Further workup ruled out the possibility of alternative primary neoplastic sites, and a diagnosis of IPSM was made. The patient was planned for radiation therapy (RT) and immune checkpoint inhibitor therapy in follow-up.

LESSONS

Fewer than 40 cases of IPSM have been described in the literature. While patients with IPSM present with progressive symptomology and unique imaging findings, surgical pathology is required for a diagnosis. The optimal treatment paradigm likely includes resection, RT, and/or systemic therapies. Molecular and genetic markers might enable more efficient diagnosis and optimize therapy for these patients.

https://thejns.org/doi/10.3171/CASE24732