Melanoma secondaries presenting as stroke.

Year : 1999 | Volume : 47 | Issue : 3 | Page : 246-7

Melanoma secondaries presenting as stroke.

Manivannan R, Aleem MA, Rajarathinam A, Rajendran P, Meikandan D, Chandrasekaran M, Raveendran S, Ramasubramanian D


Melanoma accounts for less than 2% of all cancers. Skin and eye are the most commonly affected organs. Melanocytes are derived from neural crest cells during embryonic development and get widely distributed along the cranio-spinal axis. Malignant melanomas most often present as secondary deposits arising from a primary lesion elsewhere in the body. In 1992, the International Agency for Research on Cancer, in a comprehensive review concluded `there was sufficient evidence in humans for the carcinogenicity of solar radiation, which can causes cutaneous melanoma'. Risk factors for childhood melanoma are include a gaint congenital melanocytic naevus, atypical (dysplastic) mole syndrome, xeroderma pigmentosum and immunodeficiency state.

A 26 year old male was admitted with acute onset of right hemiplegia without aphasia in March 1997 at Govt. Rajaji Hospital, Madurai. Patient was a known case of xeroderma pigmentosum since childhood. He developed gradually increasing nodular swelling over the left shoulder joint, and was diagnosed as cutaneous malignant melanoma on excision biopsy. He developed headache and vomiting, after one month, followed by sudden onset right hemiplegia with facial paresis but without aphasia. CT scan of brain showed a hypodense lesion in temporoparietal region with surrounding oedema. MRI showed a similar lesion over left temporo parietal region with surrounding oedema on T2W images [Figure 1]. The tumour was partially removed through left temporo parietal craniotomy. Histology confirmed it to be malignant melanoma. The patient was then subjected to chemotherapy and radiotherapy.

Melanoma is the third common metastasis to involve the brain after lung and breast carcinoma. Presentation is usually due to increased intra cranial pressure with headache being the primary symptoms in 45-50%, seizure in 15-22%, motor disturbance in 15% and a cerebral catastrophie in 24% of cases.[1],[2] The median interval between diagnosis of cutaneous disease and CNS involvement has variably been reported as 29 months to 42 months.[3],[4] Frontal and parietal lobes are affected most frequently. The lesions are commonly subcoritcal in location and require advanced technique of intra operative localisation. lntra cranial melanoma must be suspected if a patient with extensive pigmentation of skin or a giant pigmented naevus develops signs of an intra cranial lesion.


» References Top

1. Balasubramaniam V. Ramamurthi B : Melanoma of meninges. Neuorl India 1964; 12 : 15-17. Back to cited text no. 1
2. Bullard DE, Cox E8, Seiglar HF : Central nervous system metastasis in malignant melanoma. Neurosurgery 1981; 8 : 26-30. Back to cited text no. 2
3. Crisp DE, Thompson IA : Primary malignant melanomatosis of the meninges. Arch Neurol 1981; 38 : 528-529. Back to cited text no. 3
4. Deshpande DH, Dastur HM, Pandya SK: Primary melanoma of leptomeninges. Neurol India 1970; 12 : 15-17. Back to cited text no. 4



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