Intramedullary or invasive characteristics of spinal melanocytomas: a PRISMA compliant systematic review and pooled case analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with primary intramedullary or invasive meningeal melanocytomas of the spinal cord |
| I — Intervention | Gross-total resection (GTR) with or without adjuvant radiotherapy |
| C — Comparator | Near-total/subtotal resection (NTR/STR) with or without adjuvant radiotherapy |
| O — Outcomes | Recurrence rates, metastatic disease progression, and treatment outcomes |
Bottom Line
This systematic review challenges the traditional 'benign' classification of spinal melanocytomas when they present with intramedullary or invasive characteristics. Despite gross-total resection, recurrence rates remained substantial (26.7%), questioning whether surgical resection alone is adequate treatment. While the evidence is limited by small numbers and case report methodology, the findings suggest these rare tumours may warrant more aggressive management approaches. The potential benefit of adjuvant radiotherapy, though based on only three cases, warrants consideration in multidisciplinary planning. Australian neurosurgeons managing these rare lesions should consider individualised adjuvant radiotherapy regardless of resection extent, while acknowledging the hypothesis-generating nature of current evidence. Larger prospective studies are needed to establish definitive treatment protocols.
Key Findings
P Value: P = 0.548 (no significant difference between resection extents)
Effect Size: 26.7% recurrence after GTR vs 36.4% after NTR/STR
Primary Outcome: Recurrence rates after surgical resection
Nnt Or Sensitivity: No recurrence in 3 patients receiving adjuvant radiotherapy vs 29.6% in 27 without radiation
Confidence Interval: Not reported in abstract
Clinical Application
Applicable to tertiary neurosurgical centres with stereotactic radiotherapy capabilities Relevant to Australian neurosurgical practice; multidisciplinary team approach aligns with Cancer Council guidelines; radiotherapy access through public system Neurosurgical patients with rare intramedullary or invasive spinal melanocytomas
Abstract
PURPOSE: Primary meningeal melanocytomas (MMs) of the spinal cord are rare lesions. Even rarer are intramedullary and invasive variants. These intramedullary lesions may exhibit more aggressive behavior than their "benign" classification appreciates. The role of adjuvant radiotherapy (aRT) in this context remains uncertain. METHODS: This study is a PRISMA-compliant systematic review with a pooled-case analysis, including two recent institutional cases included as illustrative examples. RESULTS: Sixty-three reports were identified of primary intramedullary or invasive MMs. Among 56 patients with available recurrence data, 8 of 30 patients (26.7%) experienced recurrence after gross-total resection (GTR) and in 8 of 22 (36.4%) after near-total or subtotal resection (NTR/STR), with no significant difference between groups (two-sided Fisher's exact, P = 0.548). No recurrence was observed among three patients who received aRT upfront post GTR, compared with 8 of 27 (29.6%) who did not receive radiation (two-sided Fisher's exact, P = 0.545); however, this subgroup was markedly underpowered and should be interpreted as hypothesis-generating only. Nine patients developed metastatic disease or progression, including one post biopsy. Of the eight who underwent resection at index surgery, 2 (25%) had undergone GTR and 6 (75%) STR. CONCLUSIONS: These findings suggest that the designation of MMs as benign lesions may underestimate the oncologic potential of intramedullary or invasive disease. Consideration of aRT on an individualized basis for patients with intramedullary or invasive disease is reasonable, regardless of extent of resection.
References
- 1.Leon, S., Maity, A., Gluski, J., Brown, E. D. L., Elsamadicy, A. A., Santangelo, G., Lo, S. F., & Sciubba, D. M. (2026). Intramedullary or invasive characteristics of spinal melanocytomas: a PRISMA compliant systematic review and pooled case analysis. Journal of Neuro-Oncology. https://doi.org/10.21873/invivo.13558
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