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Metastatic melanoma to the spine. Demographics, risk factors, and prognosis in 114 patients
D A Spiegel1, J H Sampson, W J Richardson
1Division of Orthopaedic, Duke University Medical Center, Durham, North Carolina, USA.
Study Design:
One-hundred-fourteen patients with metastatic melanoma of the spine were retrospectively reviewed.
Objective:
The goal was to define the demographics, risk factors, and prognosis for this population.
Summary Of Background Data:
The incidence of melanoma is increasing faster than any other cancer. Therefore, orthopedic and neurologic surgeons will be increasingly confronted by patients with spinal metastases from melanoma. However, the demographics, risk factors, and prognosis remain unclear.
Methods:
From 7010 consecutive patients with melanoma, 114 were identified with clinically or radiographically evident spinal metastases. A comparison was made between these patients and the remainder of the population with melanoma seen at our institution using contingency table analysis with statistical significance determined by a chi-squared test. Survival data were represented by Kaplan-Meier curves, and log-rank testing was used for statistical comparisons.
Results:
Risk factors associated with the development of these metastases included primary lesions that were ulcerated, deeper than 0.76 mm, or of Clark level II, or located on the trunk or mucosal surfaces. The median survival time for all patients was 86 days, but this was reduced in patients with more than one metastatic site in addition to the spine.
Conclusion:
The prognosis for most patients with spinal metastases from melanoma is dismal. However, patients with metastatic disease limited to the spine and one other organ may survive for a relatively prolonged time and may be candidates for surgical intervention directed toward symptomatic relief.