Intramedullary melanocytomas are extremely rare. They have to be differentiated from melanomas and melanoma metastases. Glick et al. [106] published a series of seven patients. They performed detailed pathological examinations and concluded that mela-nocytomas lack anaplastic features but demonstrate local aggressive behavior.

On the other hand, two case reports of patients with melanocytomas have been published with rather rapid neurological progression and death. Barth et al. [16] reported on a primary intramedullary melanocy-toma of the thoracic cord in a 49-year-old woman. The tumor was resected twice and disseminated to the sacral as well as intracranial subarachnoid space. The patient died 4 years after the diagnosis had been established. Takenaka et al. [326] reported on a mela-nocytoma of the medulla oblongata. The patient died 7 months after surgery.

We have seen two female patients with thoracic melanocytomas with completely different outcomes. One 23-year-old female patient presented with a 15-month history of a moderate paraparesis. She underwent two incomplete tumor resections in 2 years with complete paraplegia and postoperative radiotherapy after the second operation. She progressed further and presented 3 years after the initial diagnosis with a massive intramedullary hemorrhage and increasing tetraparesis requiring a third operation with evacuation of the hematoma. After that operation, her upper extremity function improved again but she developed subarachnoid dissemination with intracranial seeding and died 54 months after the first operation (Fig. 3.88).

The other 62-year-old female patient demonstrated a 3-month history of increasing paraparesis due to a tumor at Th10-T12. She underwent a subtotal resection and recovered significantly after this operation. Despite incomplete resection, she received no adjuvant postoperative therapy but is free of tumor re-growth for 93 months.

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