Postoperative radiation for primary melanoma of the cervical spinal cord in a pregnant patient: A case report & review of the literature

Only 1% of melanomas present with isolated involvement of the central nervous system. Primary melanoma of the spinal cord is especially rare. There are only a handful of cases reported and only one reported during pregnancy. 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. 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 emergent Cesarean section. The procedure was performed without complications, but the patient demonstrated quadriplegia post-operatively. She then underwent surgical resection. Final post-operative imaging showed no gross disease. Pathology revealed malignant melanoma. She slowly regained neurologic function with no significant residual deficits. She received post-operative radiotherapy (37.5 Gy in 15 fractions using 3D-CRT) with minimal toxicity. 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 to primary cutaneous melanoma with spinal cord metastasis. Surgical resection is the mainstay of treatment. The role for radiotherapy is not clear. As a result, the optimal treatment for these patients should be determined on a case-by-case basis.