(P010) Postoperative Radiation for Primary Melanoma of the Cervical Spinal Cord in a Pregnant Patient: A Case Report

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OncologyOncology Vol 30 No 4_Suppl_1
Volume 30
Issue 4_Suppl_1

Due to the rarity of primary melanoma of the spinal cord, there are no standardized guidelines for treatment. Presentation during pregnancy adds more complexity.

Sarah Westergaard, Gary Lewis, MD, Todd Swanson, MD, PhD; UT Medical Branch

INTRODUCTION: Only 1% of melanomas present with isolated involvement of the central nervous system. Primary melanoma of the spinal cord, particularly cervical, is especially rare. There are only a handful of cases reported and only one reported during pregnancy. CASE

PRESENTATION: The patient was a 27-year-old female who presented with 16 weeks of neck pain and numbness in the distal upper extremities when she was 31 weeks pregnant. Magnetic resonance imaging (MRI) revealed a mass in the cervical spine. The plan was for delivery at term, followed by surgical resection. However, due to progression of symptoms, she underwent an emergent cesarean section. The procedure was performed without complications, but the patient demonstrated quadriplegia postoperatively. She then underwent C2/C3 laminectomy and resection of the mass. Interval imaging showed residual disease, and she underwent a re-resection and removal of the posterior arch of C1 and rim of the right foramen magnum. Final postoperative imaging showed no gross disease. Pathology revealed malignant melanoma. Complete dermatologic and ophthalmic evaluation did not reveal a source. The patient eventually regained strength and sensation; she was discharged with minimal neurologic deficits. She received postoperative radiotherapy (RT) (37.5 Gy in 15 fractions using three-dimensional conformal RT [3D-CRT]) with minimal toxicity.

DISCUSSION AND CONCLUSION: Due to the rarity of primary melanoma of the spinal cord, there are no standardized guidelines for treatment. Presentation during pregnancy adds more complexity. Based on prior reports, primary melanoma of the spinal cord appears to have a better overall prognosis compared with primary cutaneous melanoma with spinal cord metastasis. Surgical resection is the mainstay of treatment. The role for RT is not clear. Adjuvant radiation has been used in some reports, but an ideal target dose is not certain, given the lack of robust data. As a result, the optimal treatment for these patients should be determined on a case-by-case basis.

Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) A 15-Year Review of Radiation Therapy for Keloids at Two Institutions
(S003) Single-Fraction Radiation Therapy for the Treatment of Multiple Myeloma Bony Metastases Provides Pain Control and Decreases Time to Chemotherapy
(S001) Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation Therapy for Oropharyngeal Cancer
(S004) Trend in Second Malignancy Risk for Head and Neck Cancer With Increased Utilization of IMRT: Analysis of SEER Database
(S005) Comparison of Legal Needs of a Group of Patients With Cancer: Economic and Geographic Factors
(S006) Mission Improvement: Lessons From Initiating a Resident-Led Quality Improvement Project on Smoking Cessation at a County Hospital
(S007) Results of a Phase II Trial Using Cetuximab Plus Docetaxel With Low-Dose Fractionated Radiation for Recurrent Unresectable Locally Advanced Head and Neck Carcinoma
(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status
(S009) Intensity-Modulated Radiation Therapy With Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: A Report on Three-Year Toxicity
(S011) Comparative Study Between Ileal Conduit and Indiana Pouch After Cystectomy for Patients With Carcinoma of Urinary Bladder
(S010) Computed Tomography–Assessed Measures of Bone Mineral Density and Muscle Mass as Predictors of Survival in Men With Prostate Cancer
(S012) Quantitative Imaging to Evaluate the Malignant Potential of Pancreatic Cysts
(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma
(S014) The Impact of Radiation Therapy on Survival in Surgically Resected, High-Risk Patients With Ampullary Adenocarcinoma: A Population-Based Analysis
(S016) The Impact of Stereotactic Body Radiation Therapy on Overall Survival in Patients With Locally Advanced Pancreatic Cancer
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