Neurotropic cutaneous malignant melanoma with contiguous spread to spinal cord, an extremely rare presentation

Abstract

Neurotropic melanoma (NM) is a rare variant of cutaneous melanomas. Compared with conventional melanoma, NM is more locally aggressive with an increased tendency for local recurrence but less likely for nodal or distant metastases. The often amelanotic, benign appearance may lead to treatment issues such as late presentation, diagnostic delay, misdiagnosis, insufficient surgical margins, and recurrence with resulting poor outcome. To our knowledge, this is the first case report of NM with contiguous spread to the spinal cord. We present a case report of a 73-year-old male with gradual decline in mobility over the period of few months. He deteriorated very rapidly whilst inpatient with progressive myelopathy, loss of sphincter function and dysphonia with dysphagia due to involvement of lower cranial nerves. The neurotropic nature of the disease and prevalence in the head and neck region results in perineural and neural invasion with resulting neuropathies. Patient underwent posterior cervical decompression and resection of the higher cervical intramedullary spinal cord NM lesion. He recovered well with improvement of his limb weakness as well as bulbar function. Wide local excision (WLE) with adjuvant radiotherapy where indicated remains the current practice for treatment, with chemotherapy predominately being reserved as a salvage treatment for patients with disseminated disease.

Intramedullary Spinal Cord Metastases from Differentiated Thyroid Cancer, a Case Report

“…In half of the cases, lung cancer is the most common ISCM-related tumor and small cell lung cancer is the most common subtype. Other than this, ISCM may be seen in breast cancer (13%), renal cancer (4%), melanomas (9%), and/or lymphomas (5%) [ 7 , 8 , 9 , 10 , 11 ]. In metastatic spinal tumors, the age of diagnosis is frequently from 50 to 60 years.…”

“…Symptoms such as pain and myelopathy develop within 2 months and plegia may develop in 10–15% of cases [ 3 ]. Motor deficits, sphincter problems, and sensory disorders are very common [ 10 , 12 ]. MR plays an important role in surgical planning when ISCM is suspected in the differential diagnosis.…”

A Rarely Seen Pathology "Intramedullary Spinal Metastasis"; Clinical Series of Five Patients in a Single Institution

“…Lung cancer is the most common (54%) ISCM-causing tumor, and small cell lung cancer is the most common subtype. Other than this, ISCMs may be seen in breast cancer (13%), renal cancer (4%), melanomas (9%), and/ or lymphomas (5%) (6)(7)(8)(9)(10).…”

“…It is reported that symptoms occur in 2 months on average, the first complaint is pain and myelopathy, and plegia may develop in 10%-15% of cases (3). More than half of the cases have motor deficits, and approximately half of them have sphincter problems and sensory disturbances (9,12). Magnetic resonance image (MRI) plays an important role in surgical planning when ISCM is suspected in the differential diagnosis.…”