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