Title : What is the best therapeutic regimen for primary CNS melanomas? A case report and critical review of literature
Abstract:
Background: Melanocytes, responsible for melanin production, originate from the neural crest and can give rise to malignant tumors known as melanoma. Primary Central Nervous System Melanoma (pCNSM) is a rare occurrence, with an incidence of 0.005 cases per 100,000 individuals annually. Considering this rare occurrence and variations in tumor biology, a comprehensive treatment strategy has not been introduced yet. Immunotherapy is an emerging treatment avenue warranting further exploration.
Objectives: In this paper, we conducted an extensive literature review on patients with pCNSM including brain and spine to figure out the most successful treatment protocol. We shared our case of a teenage girl diagnosed initially as an arteriovenous malformation; however, she was found to have a pCNSM Melanoma.
Materials and Methods: A systematic review of literature of all published articles from 1980 till 2023 was conducted. The data were collected from the primary data sources included PubMed and Google Scholar, electronic medical records, multiple published case studies, and Archives of the American Institute for Radiologic Pathology.
Results: The systematic review found 138 articles with 148 pCNSMs (77 cases of brain and 71 cases of spinal primay melanoma) spanning since 1980 to 2023. The vast majority of patients (95%) underwent therapeutic gross total or partial resection of the tumors followed by radiotherapy. Only two cases with brain melanomas underwent immunotherapy including our case. The treatment strategies of primary brain melanomas were similar to those of Primary Spinal Melanoma (PSM) but exhibited better outcomes in PSM cases.
Conclusion: Our findings suggest that surgical intervention, followed by adjuvant radiotherapy + immuntherapy, yields favourable outcomes in PSM cases, but not in primary brain melanomas. Further multicentric studies are needed to explore alternative more effective treatment modalities.
Keywords: Brain Neoplasms, Spinal neoplasms, Melanoma, primary
Audience Take Away Notes:
- Audience Utilization The audience, in particular those who treat and manage melanoma, can make better use of the research's findings by incorporating them into their treatment plans.
- Professionals will be able to improve their effectiveness in treating melanoma patients, potentially leading to better patient outcomes and satisfaction. It will also help them stay updated with the latest research and treatment protocols in this rare condition.
- Faculty Research and Teaching This research could serve as a valuable resource for other faculty members interested in expanding their research or teaching in the field of melanoma treatment. It provides a comprehensive review of existing literature and presents new insights into the treatment of primary CNS melanoma.
- Useful Solution The results can assist medical technology designers and developers in creating more effective and efficient treatment methods. This could make treatment planning easier and result in better patient care.
- Enhanced Precision and Novel Data: Through an extensive analysis of existing research and results, this study offers fresh insights that may help to improve treatment guidelines and enhance the precision of diagnosis and prognosis for individuals suffering with primary CNS melanoma.
- Other Benefits:
- It helps to bridge the gap in knowledge regarding the treatment of a rare condition like primary CNS melanoma.
- It offers a foundation for additional study and the creation of creative treatment plans.
- It might result in melanoma patients having a higher quality of life. It may facilitate the development of new drugs or therapies for melanoma treatment.
