Metastatic spinal melanoma is a rare and aggressive disease process with poor prognosis. We review the literature on metastatic spinal melanoma, focusing on its epidemiology, management, and treatment outcomes. Demographics of metastatic spinal melanoma are similar to those for cutaneous melanoma, and cutaneous primary tumors tend to be most common. Decompressive surgical intervention and radiotherapy have traditionally been considered mainstays of treatment, and stereotactic radiosurgery has emerged as a promising approach in the operative management of metastatic spinal melanoma. While survival outcomes for metastatic spinal melanoma remain poor, they have improved in recent years with the advent of immune checkpoint inhibition, used in conjunction with surgery and radiotherapy. New treatment options remain under investigation, especially for patients with disease refractory to immunotherapy. We additionally explore several of these promising future directions. Nevertheless, further investigation of treatment outcomes, ideally incorporating high-quality prospective data from randomized controlled trials, is needed to identify optimal management of metastatic spinal melanoma.

BACKGROUND: Primary spinal melanoma is extremely rare, accounting for ∼1% of all primary melanomas. Typically presenting insidiously in the thoracic spinal cord, primary spinal melanomas can have an acute presentation due to their propensity to hemorrhage.
METHODS: Despite its rarity, primary spinal melanoma should be included in the differential diagnosis when a hemorrhagic pattern of T1 and T2 intensities is seen on magnetic resonance imaging. Furthermore, the complete diagnosis is crucial because the prognosis of a primary spinal melanoma is considerably more favorable than that of a primary cutaneous melanoma with metastatic spread.
CONCLUSIONS: Resection is the treatment of choice, with some authors advocating for postoperative chemotherapy, immunotherapy, and/or radiation. We describe a case of acute quadriplegia from hemorrhagic primary spinal melanoma requiring resection.

Complex neurocristopathy, a disorder resulting from the aberrant proliferation of tissues derived from neural crest cells, has been previously reported in 2 patients, both involving ophthalmic melanoma and other tumors. One patient had a periorbital neurofibroma, sphenoid wing meningioma, and choroid juxtapapillary meningioma. The other patient had a choroidal melanoma and an optic nerve sheath meningioma. The authors describe clinical and pathological findings in a patient who underwent resection of 2 distinct lesions: primary CNS melanoma at T-12 and an L-5 schwannoma. Clinical and histopathological findings of the case are reviewed. To the authors\' knowledge, this is the first patient to present with complex neurocristopathy involving both a spinal melanoma and schwannoma.