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Neurological Rehabilitation

(Kiosk 3) A Rare Case of Primary Intramedullary Spinal Melanoma

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Nicholas Abramson, MD

    Resident
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

    • Co-Author(s)

  • Devon Shannon, MD

    Resident Physician
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

  • JM

    James W. Morgan, MD

    Assistant professor
    Vanderbilt University Medical Center
    Nashville, Tennessee

Case Diagnosis: Primary Intramedullary Spinal Melanoma

Case Description or Program Description: 44 year old female who presented with one month of subacute low back pain, saddle anesthesia, lower extremity paresthesias, and two weeks of urinary retention. MRI showed intramedullary T1 and T2 enhancing mass and hemorrhage at T10 and T11, as well as T8 through conus edema. CSF studies were negative. Ultimately she underwent laminectomy and intramedullary excisional biopsy which showed melanoma. Dermatology and ophthalmology performed a comprehensive skin examination on several occasions and were unable to detect a primary melanoma on her skin or eyes; she was ultimately felt to have a primary spinal melanoma. She began inpatient rehabilitation (IPR) during which time she underwent postoperative radiation.

Setting: Inpatient Rehabilitation

Assessment/Results: With full neurological evaluation at IPR, she was found to have T10 AIS C motor incomplete paraplegia. She had significant impairments in mobility, dressing and hygiene. However, she made excellent functional gains and ultimately discharged home as T10 AIS D. She continued to make significant functional gains with outpatient physical and occupational therapy.

Discussion (relevance): Primary intramedullary spinal melanoma is very rarely reported in available literature. Melanoma arising in the CNS accounts for less than 1% of all reported melanomas, and melanoma arising in the spinal cord is even rarer. It has most commonly been reported as arising in the lower or middle thoracic spinal cord. Primary melanomas in the cord are proposed to arise from pial epithelial cells. These melanocytes are most seen in the cerebellum and spinal medulla. Tumor should be suspected when T1 images show hyperintensity and T2 images show iso or hypointensity. However, these features can be variable depending on tumor characteristics.

Conclusions: While malignant melanoma often has a very poor prognosis, surgical resection and rehabilitation provide avenues for functional improvement.