The management of metastatic spinal melanoma involves maximizing local control, preventing recurrence, and minimizing treatment-associated toxicity and spinal cord damage. Additionally, therapeutic measures should promote mechanical stability, facilitate rehabilitation, and promote quality of life. These objectives prove difficult to achieve given melanoma's elusive nature, radioresistant and chemoresistant histology, vascular character, and tendency for rapid and early metastasis. Different therapeutic modalities exist for metastatic spinal melanoma treatment, including resection (definitive, debulking, or stabilization procedures), stereotactic radiosurgery, and immunotherapeutic techniques, but no single treatment modality has proven fully effective. The authors present a conceptual overview and critique of these techniques, assessing their effectiveness, separately and combined, in the treatment of metastatic spinal melanoma. They provide an up-to-date guide for multidisciplinary treatment strategies. Protocols that incorporate specific, goal-defined surgery, immunotherapy, and stereotactic radiosurgery would be beneficial in efforts to maximize local control and minimize toxicity.
Keywords: CTLA-4 = cytotoxic T-lymphocyte antigen–4; IFN = interferon; IL-2 = interleukin-2; LINAC = linear accelerator; MHC = major histocompatibility complex; NK = natural killer; NOMS = Neurological deficits, Oncological features, Mechanical spinal instability, and Systemic disease progression; PD-1 = programmed death–1; PD-L1, -L2 = programmed death–1 ligands 1 and 2; SRS = stereotactic radiosurgery; TIL = tumor-infiltrating lymphocyte; Th1 = helper T cell Type 1; cEBRT = conventional external-beam radiation therapy; immunotherapy; metastatic spinal melanoma; review; separation surgery; stereotactic radiosurgery.