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Purpose <p>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.</p> Methods <p>This study is a PRISMA-compliant systematic review with a pooled-case analysis, including two recent institutional cases included as illustrative examples.</p> Results <p>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, <i>P</i> = 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, <i>P</i> = 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.</p> Conclusions <p>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.</p>

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Intramedullary or invasive characteristics of spinal melanocytomas: a PRISMA compliant systematic review and pooled case analysis

  • 期刊论文

  • 发表日期：

    2026年5月28日

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  • Sebastian Leon,
  • Apratim Maity,
  • Jacob Gluski,
  • Ethan D. L. Brown,
  • Aladine A. Elsamadicy,
  • Gabrielle Santangelo,
  • Sheng-fu Lo,
  • Daniel M. Sciubba

摘要

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.