Primary Extradural Melanoma Arising in Cervical Spinal Nerve Root

Area of Science:

• Oncology
• Neurosurgery
• Dermatology

Background:

• Primary cervical melanoma is an exceedingly rare diagnosis, particularly when originating extradurally within a nerve root.
• Characterization of such rare cases is crucial for advancing the management of melanoma.

Observation:

• A 42-year-old female presented with a 5-year history of right shoulder and arm numbness and pain.
• Magnetic resonance imaging revealed an epidural mass at the C7-T1 intervertebral foramen, initially suspected to be a nerve sheath tumor.
• Histopathology post-resection confirmed the mass as malignant melanoma.

Findings:

• The patient developed hepatic metastases 2 months after initial radiotherapy and chemotherapy (temozolomide and cisplatin).
• A modified regimen of carboplatin, nab-paclitaxel, and recombinant human endostatin injections was administered for 6 months.
• Follow-up at 16 months post-surgery indicated a favorable prognosis.

Implications:

• Radiographic findings for spinal melanoma are often equivocal, underscoring the need for histopathologic confirmation.
• This case highlights a potential treatment strategy for primary extradural spinal melanoma with hepatic metastasis.
• The described chemotherapy regimen may offer broader implications for advanced melanoma treatment.