Intramedullary spinal cord metastasis from malignant melanoma: a case report of a central nervous system secondary lesion occurred 15 years after the primary skin lesion resection

According to the latest studies, nearly half of patients with melanoma will experience metastases to the central nervous system (CNS) [3]. Intramedullary metastases give symptoms associated with tumor mass compression on the spinal cord at a given level. The main goal of treating this type of cancer is to improve the patient’s neurological state [4]. In this paper we report a case of intramedullary spinal cord metastasis from malignant melanoma detected 15 years after the primary skin lesion resection.
A 49-year-old female patient was admitted to the Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery in March 2009 for diagnosis and treatment of back pain. The patient had previously been diagnosed with malignant melanoma (I B) of the left forearm. The lesion underwent extensive surgical resection in February 1994. No recurrence or metastasis has appeared since then. In examination on admission, the following was established: good general condition, back pain at the lower part of the thoracic spine, spasticity of the lower limbs, and no sensory disturbance. Thoracic spine magnetic resonance imaging (MRI) with contrast showed a longitudinal pathological mass (22.8 mm × 9.8 mm × 8.3 mm) within the spinal cord at Th11 level, widening the spinal cord and following a gadolinium-contrast injection homogeneously enhancing the surface of the spinal cord. Based on clinical symptoms and MRI image, the patient was qualified for an emergency surgical treatment.
The surgery confirmed the presence of intramedullary tumor at level Th11. On opening the dura, there appeared a visibly swollen area of the spinal cord at the surgery level. A linear midline incision was made, revealing tumor masses. Macroscopically the lesion was totally removed. After surgery, the patient’s neurological condition improved. Early postoperative rehabilitation was implemented. Until the end of stay at the Department of Neurosurgery, gradual regression of both lower limbs paresis was observed.
In a histopathological examination, immunohistochemical staining showed positivity for HMB45 and Melan-A (Figure 1), which confirmed the diagnosis of melanoma metastasis. On the 14th day after surgery the patient was discharged from the clinic in a good general condition, walking.
Intramedullary malignant melanoma is extremely rare [5–7]. In case of skin melanoma metastasis to the spinal cord, prognosis is worse than for primary CNS melanoma [8]. These tumors...


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