Metastatic spinal melanoma is a rare and aggressive disease process with poor prognosis. We review the literature on metastatic spinal melanoma, focusing on its epidemiology, management, and treatment outcomes. Demographics of metastatic spinal melanoma are similar to those for cutaneous melanoma, and cutaneous primary tumors tend to be most common. Decompressive surgical intervention and radiotherapy have traditionally been considered mainstays of treatment, and stereotactic radiosurgery has emerged as a promising approach in the operative management of metastatic spinal melanoma. While survival outcomes for metastatic spinal melanoma remain poor, they have improved in recent years with the advent of immune checkpoint inhibition, used in conjunction with surgery and radiotherapy. New treatment options remain under investigation, especially for patients with disease refractory to immunotherapy. We additionally explore several of these promising future directions. Nevertheless, further investigation of treatment outcomes, ideally incorporating high-quality prospective data from randomized controlled trials, is needed to identify optimal management of metastatic spinal melanoma.
Keywords: CAR, chimeric antigen receptor; CNS, central nervous system; HMB-45, human melanoma black 45; ICIs, immune checkpoint inhibitors; MEK, mitogen-activated protein kinase; MRI, magnetic resonance imaging; Melanoma; Neuroimmunology; Neurooncology; PD-1, programmed death receptor-1; SRS, stereotactic radiosurgery; Spinal melanoma; Spinal metastasis; T-VEC, talimogene laherparepvec.
© 2023 The Authors.