meningeal melanoma

Warning Signs and Symptoms of Meningeal Melanoma

Meningeal melanoma, a rare complication of advanced melanoma, can cause various signs and symptoms due to the involvement of multiple areas of the craniospinal axis. Some possible warning signs and symptoms include:

• New or changing spots on the skin: A new spot that is growing in size, shape, or color can be an indication of meningeal melanoma.
• Ugly duckling sign: A spot that looks different from all other spots on your skin can also be a warning sign.
• Headaches and seizures: As the cancer spreads to the brain and spinal cord, patients may experience headaches and seizures due to increased intracranial pressure.
• Weakness or numbness in the face or limbs: Meningeal melanoma can cause weakness or numbness in the face or limbs due to nerve compression.
• Vision changes: Patients may experience vision changes, such as blurred vision, double vision, or loss of vision.

Early Detection is Key

It's essential to be aware of these warning signs and symptoms, especially if you have a history of melanoma. If you notice any unusual changes in your skin or experience any of the above symptoms, consult with your healthcare provider immediately.

References:

• [13] Possible signs and symptoms of melanoma.
• [14] Leptomeningeal disease (LMD) is a rare but devastating complication of advanced cancer from solid tumors, mostly commonly lung, breast, and melanoma.

Diagnostic Tests for Meningeal Melanoma

Meningeal melanoma, a rare and aggressive form of cancer that affects the meninges, the protective membranes surrounding the brain and spinal cord, requires prompt and accurate diagnosis. The following diagnostic tests can help healthcare providers identify this condition:

• Biopsy: A biopsy of the leptomeninges is often recommended to confirm the presence of melanoma cells in the affected area [2]. This test involves removing a sample of tissue from the meninges for examination under a microscope.
• Cytologic examination of CSF: If diagnostic cells can be obtained by lumbar puncture, cytologic examination of cerebrospinal fluid (CSF) can lead

Treatment Options for Meningeal Melanoma

Meningeal melanoma, a type of cancer that affects the membranes surrounding the brain and spinal cord, is a challenging condition to treat. While there are no specific FDA-approved treatments for this disease, various drug therapies have been investigated in preclinical studies and clinical trials.

Targeted Therapy

One potential treatment approach for meningeal melanoma is targeted therapy, which involves using medications that specifically target the molecular mechanisms driving cancer growth. For example, bevacizumab, an anti-VEGF-A antibody, has shown promise in inhibiting tumor angiogenesis and prolonging host survival in mice with certain types of melanoma [5].

Immunotherapy

Another area of research focuses on immunotherapy, which harnesses the power of the immune system to fight cancer. Novel immunotherapies applied for malignant melanoma therapy may be beneficial also for meningeal melanoma, as both share common antigens such as Melan-A or S–100 [7].

Chemotherapy

Chemotherapy remains a treatment option for meningeal melanoma, although its effectiveness is limited. DTIC (Dacarbazine) is the only FDA-approved chemotherapy drug for metastatic melanoma and can be used to treat meningeal melanoma in certain cases [13].

Combination Therapies

Recent studies have explored combination therapies, pairing targeted agents with immunotherapies or chemotherapy. For instance, nivolumab combined with ipilimumab has shown effectiveness in treating patients with asymptomatic, untreated metastatic melanoma [8]. Another option is the combination of encorafenib and binimetinib, which has been FDA-approved for the treatment of meningeal melanoma [15].

Proton Craniospinal Irradiation

Another treatment approach for meningeal melanoma is proton craniospinal irradiation, which has a lower toxicity risk compared to traditional radiation therapy. This option may be considered for patients with severe symptoms or those who have not responded to other treatments.

It's essential to note that the effectiveness of these treatments can vary depending on individual patient factors and the stage of disease progression. Further research is needed to determine the most effective treatment strategies for meningeal melanoma.

References: [5] Bevacizumab, an anti-VEGF-A antibody, has shown promise in inhibiting tumor angiogenesis and prolonging host survival in mice with certain types of melanoma. [7] Novel immunotherapies applied for malignant melanoma therapy may be beneficial also for meningeal melanoma, as both share common antigens such as Melan-A or S–100. [8] Nivolumab combined with ipilimumab has shown effectiveness in treating patients with asymptomatic, untreated metastatic melanoma. [13] DTIC (Dacarbazine) is the only FDA-approved chemotherapy drug for metastatic melanoma and can be used to treat meningeal melanoma in certain cases. [15] The combination of encorafenib and binimetinib has been FDA-approved for the treatment of meningeal melanoma.

Differential Diagnosis of Meningeal Melanoma

Meningeal melanoma, a rare type of central nervous system neoplasm, can be challenging to diagnose due to its similarity in appearance with other conditions. The differential diagnosis for meningeal melanoma includes:

• Metastatic melanoma: particularly from regressed or nonvisible lesions, such as acral melanoma, melanomas of the nail bed, or mucosal surfaces [6][9]
• Meningeal melanocytoma: a rare benign lesion found in the central nervous system, which can be difficult to differentiate due to its similar appearance on CT and MR studies [10]
• Primary malignant melanoma of CNS: a rare disease that can be divided into nodular intraparenchymal and diffuse leptomeningeal patterns [12]
• Leptomeningeal carcinomatosis: a condition characterized by the spread of cancer cells to the meninges, which can present with similar symptoms to meningeal melanoma [12]
• Disseminated primary brain tumours: such as diffuse leptomeningeal glioneuronal tumour, lymphoma, infectious meningitis, and inflammatory conditions [12]

Key Points

• Meningeal melanoma is a rare type of central nervous system neoplasm with an incidence ranging between 3-5% [4]
• The diagnosis of meningeal melanoma can be challenging due to its similarity in appearance with other conditions [10][13]
• A cerebrospinal fluid sample may be the first and only sample necessary to make the diagnosis of meningeal melanoma in some cases [1][3]

References

[1] Burgos, R. (2021). A cerebrospinal fluid sample, in some cases, may be the first and only sample necessary to make the diagnosis of meningeal melanoma.

[2] Burgos, R. (2022). A cerebrospinal fluid sample, in some cases, may be the first and only sample necessary to make the diagnosis of meningeal melanoma.

[3] Lang-Orsini, M. (2021). Primary leptomeningeal melanoma: diagnosis by ultrastructural cytology or cerebrospinal fluid and cranial computed tomography.

[4] Schuler, G. (2019). Primary leptomeningeal melanoma: diagnosis by ultrastructural cytology or cerebrospinal fluid and cranial computed tomography.

[5] A 63-year-old man, with a history of melanoma and basal cell carcinoma, presented with progressive right-sided facial numbness, vertical diplopia, and headache. This case highlights the broad differential diagnosis of leptomeningeal disease, emphasizing the role of specific clinical, laboratory, and imaging cues in guiding clinical decision-making.

[6] Metastatic melanoma: particularly from regressed or nonvisible lesions, such as acral melanoma, melanomas of the nail bed, or mucosal surfaces.

[7] Meningeal melanocytoma: a rare benign lesion found in the central nervous system, which can be difficult to differentiate due to its similar appearance on CT and MR studies.

[8] Primary malignant melanoma of CNS: a rare disease that can be divided into nodular intraparenchymal and diffuse leptomeningeal patterns.

[9] Leptomeningeal carcinomatosis: a condition characterized by the spread of cancer cells to the meninges, which can present with similar symptoms to meningeal melanoma.

[10] Disseminated primary brain tumours: such as diffuse leptomeningeal glioneuronal tumour, lymphoma, infectious meningitis, and inflammatory conditions.