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Introduction <p>Spinal melanocytic tumors are rare, with limited data on their clinical course and aggressiveness. Since intraoperative dark pigmentation and infiltrative margins can lead to misclassification of MC as MM—especially in the absence of a known primary—this multicenter study characterizes melanocytomas (MC) and contrasts them with malignant melanoma (MM).</p> Methods <p>We retrospectively analyzed 56 patients with spinal intradural melanocytic tumors (2010–2024) from seven European neurosurgical centers. Clinical, radiological, histological, and surgical features were analyzed. Univariate and multivariate analyses were performed to identify prognostic risk factors.</p> Results <p>The study included 22 patients with spinal MC and 34 patients with MM. Median age was comparable (61 vs. 58 years, <i>p</i> = 0.09), but MC patients had a longer symptom history (13 vs. 1.3 months, <i>p</i> = 0.0001) and more often intramedullary tumors (72.7% vs. 2.9%, <i>p</i> &lt; 0.0001). Gross total resection was achieved in 40.9% of MC cases and 61.8% of MM cases (<i>p</i> = 0.07), with instrumentation required more often for MM (<i>p</i> = 0.0022). Ki-67 proliferation index was significantly higher in MM than MC (26.7% vs. 6.6%, <i>p</i> &lt; 0.0001). Postoperative deficits were more frequent in MC (54.6% vs. 14.7%, <i>p</i> = 0.002) and MCs showed higher frequency of ataxia postoperatively (36.4% vs. 11.8%, <i>p</i> = 0.04). MM patients received more adjuvant therapy (88.2% vs. 31.8%, <i>p</i> = 0.0001), with a trend toward higher local recurrence (26.5% vs. 14.7%, <i>p</i> = 0.31).</p> Conclusion <p>Our study demonstrates that MC, though considered benign, carries a high risk of postoperative deficits. Furthermore, GTR was achieved in only 40% of cases, underscoring its locally infiltrative nature and potential for semi-benign biology.</p>

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Benign or aggressive? Understanding spinal melanocytomas in comparison to malignant melanoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月1日

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  • Alice Ryba,
  • Theresa Mohme,
  • Johannes Kerschbaumer,
  • Emily von Bronewski,
  • Vanessa Hubertus,
  • Vicki M. Butenschoen,
  • Andreas Kramer,
  • Felix C. Stengel,
  • Martin N. Stienen,
  • Marco Battistelli,
  • Filippo Maria Polli,
  • Hanno S. Meyer,
  • Lasse Dührsen,
  • Klaus Christian Mende,
  • Manfred Westphal,
  • Florian Ringel,
  • Bernhard Meyer,
  • Julia Onken,
  • Claudius Thome,
  • Sven O. Eicker,
  • Malte Mohme

摘要

Introduction

Spinal melanocytic tumors are rare, with limited data on their clinical course and aggressiveness. Since intraoperative dark pigmentation and infiltrative margins can lead to misclassification of MC as MM—especially in the absence of a known primary—this multicenter study characterizes melanocytomas (MC) and contrasts them with malignant melanoma (MM).

Methods

We retrospectively analyzed 56 patients with spinal intradural melanocytic tumors (2010–2024) from seven European neurosurgical centers. Clinical, radiological, histological, and surgical features were analyzed. Univariate and multivariate analyses were performed to identify prognostic risk factors.

Results

The study included 22 patients with spinal MC and 34 patients with MM. Median age was comparable (61 vs. 58 years, p = 0.09), but MC patients had a longer symptom history (13 vs. 1.3 months, p = 0.0001) and more often intramedullary tumors (72.7% vs. 2.9%, p < 0.0001). Gross total resection was achieved in 40.9% of MC cases and 61.8% of MM cases (p = 0.07), with instrumentation required more often for MM (p = 0.0022). Ki-67 proliferation index was significantly higher in MM than MC (26.7% vs. 6.6%, p < 0.0001). Postoperative deficits were more frequent in MC (54.6% vs. 14.7%, p = 0.002) and MCs showed higher frequency of ataxia postoperatively (36.4% vs. 11.8%, p = 0.04). MM patients received more adjuvant therapy (88.2% vs. 31.8%, p = 0.0001), with a trend toward higher local recurrence (26.5% vs. 14.7%, p = 0.31).

Conclusion

Our study demonstrates that MC, though considered benign, carries a high risk of postoperative deficits. Furthermore, GTR was achieved in only 40% of cases, underscoring its locally infiltrative nature and potential for semi-benign biology.