Medical Student California Northstate University Elk Grove, California, United States
Introduction: Primary malignant melanomas are rare neoplasms that can originate in the central nervous system (CNS), with these tumors accounting for roughly 0.1% of intracranial neoplasms. Prognosis is very poor after diagnosis but treatment is typically resection followed by radiotherapy or systemic therapy, such as chemotherapy. Our study examines updated incidence of these neoplasms using the most recent SEER Database and looks for trends in survival amongst different treatment modalities.
Methods: We performed a retrospective analysis of the NCI Seer Database from 2000-2017, looking for malignant melanomas originating from the CNS. Baseline patient characteristics such as age, sex, and race as well as primary site, treatment modalities and survival were all collected. Kaplan-Meier plots were generated and to calculate survival and univariate analysis by Mantel-Cox was used to confirm survival benefits between treatment modalities.
Results: Our query turned up 48 patients, with a median age of 56 (st. deviation 20.5), 32 (66.7%) males, 39 White patients (81.3%), 2 Black (4.2%), 6 Asian/American Indian/Pacific Islander/AK native (12.5%), and 1 unknown race (2.1%). The most common primary site was the spinal cord (8, 16.7%) and spinal meninges (7, 14.6%). Surgery was performed on 33 (68.8%), systemic therapy on 8 (16.7%) and radiation on 17 (37.5%). Out of 48, 38 patients died (79.2%) with a median survival time of 9 months (SD 49.8 months). Only surgery + systemic therapy combined showed a survival benefit versus no treatment (6 months vs. 38 months, Mantel-Cox p-value = .0491).
Conclusion : Primary CNS melanomas remain a very rare intracranial tumor diagnosis with poor survival outcomes. Typical therapy involving surgery and radiation seems to confer modest benefit when compared with combination surgery and systemic therapy.
