Primary Cervicomedullary Junction Melanocytic Melanoma: An Illustrated Case Report

A 40-year-oldman presented with a 6-month history of insidious and gradual onset of progressive pain in right shoulder and neck. He also noted progressive weakness of his right upper and lower limb. A magnetic resonance imaging (MRI) of his brain and spine was performed that revealed an intradural extramedullary lesion at the cervicomedullary junction (CMJ), for which he underwent surgery in February 2009. The histopathological diagnosis was melanocytic neoplasm of intermediategrademalignancy. The symptoms reoccurred in October 2012, and a repeat MRI of the cervical spine was performed that revealed recurrent lesions at the CMJ. The patient was referred to our tertiary center for further management. Figure 1 shows the images obtained before the second surgery (2012), and Figure 2 displays the follow-up images obtained after thesecondsurgery (2014).MRI showedwell-defined intradural extramedullary lesionsat theCMJ.Onplain T1-weighted sagittal views (Figs 1A and 2A), the mass was hyperintense (white arrows); on plain T2-weighted sagittal views (Figs 1B and 2B), it showed hypointense signal intensity (arrowheads). Postcontrast T1-weighted coronal views (Figs 1C and 2C) showed intense postcontrast enhancement (yellow arrows). The imaging findings described were diagnostic for melanoma.