Low back pain as the presenting sign in a patient with primary extradural melanoma of the thoracic spine - A metastatic disease 17 Years after complete surgical resection

Abstract

Primary spinal melanomas are extremely rare lesions. In 1906, Hirschberg reported the first primary spinal melanoma, and since then only 40 new cases have been reported. A 47-year-old man was admitted suffering from low back pain, fatigue and loss of body weight persisting for three months. He had a 17-year-old history of an operated primary spinal melanoma from T7-T9, which had remained stable for these 17 years. Routine laboratory findings and clinical symptoms aroused suspicion of a metastatic disease. Multislice computed tomography and magnetic resonance imaging revealed stage-IV melanoma with thoracic, abdominal and skeletal metastases without the recurrence of the primary process. Transiliac crest core bone biopsy confirmed the diagnosis of metastatic melanoma. It is important to know that in all cases of back ore skeletal pain and unexplained weight loss, malignancy must always be considered in the differential diagnosis, especially in the subjects with a positive medical history. Patients who have back, skeletal, or joint pain that is unresponsive to a few weeks of conservative treatment or have known risk factors with or without serious etiology, are candidates for imaging studies. The present case demonstrates that complete surgical resection alone may result in a favourable outcome, but regular medical follow-up for an extended period, with the purpose of an early detection of a metastatic disease, is highly recommended.

Primary spinal melanoma of extramedullary origin: a report of three cases and systematic review of the literature

“…Currently, it has not been confirmed whether postoperative radiotherapy or chemotherapy (such as interferon, methotrexate and temozolomide) has a significant role in overall survival time. 5,6,10,11,17,18,21 Although immunotherapy is the current paradigm shift in management of melanoma, the role of immunotherapy in these rare and particular cases have not yet been documented in the literature.…”

“…3,8,17,21,22 Of the total 27 cases, only 2 cases had recurrence records. 14,17 The survival time of PSM was between 2 weeks and 17 years (median time: Abbreviations: Ch, chemotherapy; da, days; Enh, enhancement; F, female; Hyper-, hyperintense; hypo-, hypointense; M, male; mo, months; NS, not stated; Rad, radiotherapy; wk, weeks; yr, years.…”

“…Radiotherapy (from 30 to 60 Gy; median dose: 33.5 Gy) is effective for local control and is reserved for palliation of symptoms due to spinal cord compression or as an adjuvant to laminectomy. 5,6,10,11,17,18,21 Melanoma is also refractory to most systemic chemotherapies. Currently, it has not been confirmed whether postoperative radiotherapy or chemotherapy (such as interferon, methotrexate and temozolomide) has a significant role in overall survival time.…”

Primary Malignant Melanoma of the Lumbar Spine

“…Primary melanoma of the spine is likely contained due melanocytes in the leptomeninges, which can easily spread into the local bone in a necrotic and destructive fashion. The initial research conducted by Virchow in the mid 1800s show that the melanomas developed from precursor cells in the leptomeninges known as melanoblasts [8]. These melanoblasts can differentiate into a variety of masses included melanocytomas, pigmented schwannomas and pigmented neuroblastomas.…”

“…As with all tumors obtaining a biopsy is vital in order to secure the diagnosis. Metastasis of primary melanoma is extremely rare due the lack of lymphatic spread from fewer lymphatic vessels within neural tissues [8].…”