Journal Article

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

Cikes, Nada, Anic, Branimir, Zarkovic, Kamelija, Mayer, Miroslav, Plestina, Stjepko, Sentic, Mirna, Katalinic, Darko, Dotlic, Snjezana, Stern-Padovan, Ranka

2011

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Back pain / Care and treatment / Case Report / Case studies / Colleges & universities / Data collection / Development and progression / Diagnosis / Diagnosis, Differential / Family medical history / Hospitalization / Humans / low back pain / Low Back Pain - diagnosis / Low Back Pain - etiology / Low Back Pain - therapy / Magnetic Resonance Imaging / Male / Medical imaging / Medicine / Medicine & Public Health / Melanoma / Melanoma - complications / Melanoma - secondary / Melanoma - surgery / metastatic disease / Middle Aged / Patient education / Postoperative Complications / primary spinal melanoma / Rheumatology / Spinal Neoplasms - complications / Spinal Neoplasms - pathology / Spinal Neoplasms - surgery / Surgical Oncology / Thoracic Neoplasms - pathology / Thoracic Vertebrae - pathology / Tomography / Tomography, X-Ray Computed / Weight control