Intramedullary primary spinal cord melanoma: illustrative case

Area of Science:

• Neuro-oncology
• Spinal Surgery
• Oncology

Background:

• Intramedullary primary spinal melanoma (IPSM) is an exceptionally rare spinal tumor.
• Limited data exists on its clinical, radiographic, histopathological, and genetic characteristics, as well as management strategies.

Purpose of the Study:

• To describe a case of intramedullary primary spinal melanoma (IPSM).
• To highlight the diagnostic challenges and potential treatment pathways for this rare condition.

Main Methods:

• A 49-year-old male with progressive upper-extremity radiculopathy underwent MRI, revealing an intramedullary C6-T1 tumor.
• Surgical resection was performed using intraoperative dorsal column mapping for safe myelotomies.
• Histopathological analysis confirmed melanoma, with further workup excluding other primary sites.

Main Results:

• Gross-total resection of the intramedullary tumor was achieved.
• Postoperatively, the patient experienced mild sensory deficits but maintained full motor strength.
• Diagnosis of IPSM was confirmed, and the patient was planned for adjuvant radiation and immunotherapy.

Conclusions:

• Fewer than 40 cases of IPSM have been reported globally.
• Diagnosis relies on surgical pathology, often preceded by progressive symptoms and characteristic imaging.
• Multimodal treatment including surgery, radiation, and systemic therapies is likely optimal, with potential for molecular markers to guide future treatment.