Metastatic spinal cord compression: The hidden danger

Background: A 47-year-old male underwent resection of a left-shoulder melanoma in 1997. In November 2004 he was found to have multiple brain lesions and adrenal, lung, and bone metastases, and in January 2005 underwent resection of his symptomatic right parietal lobe lesion and subsequent whole-brain radiation. In February 2005 he experienced headaches and word-finding difficulty and was found to have four progressive brain lesions on MRI. These were resistant to conventional radiotherapy and were treated with stereotactic radiosurgery. The patient later developed an obstruction of the jejunum and underwent resection of multiple abdominal masses. In April 2005, the patient commenced temozolomide and underwent radiation therapy to the left arm for pain thought to be caused by an increase in size of his melanoma metastasis. In August 2005 the patient reported persistent and worsening arm pain, despite a further course of radiotherapy in June 2005. Investigations: Physical examination including a thorough neurological examination, radiography, X-ray, CT scan, and MRI. Diagnosis: Metastatic melanoma to the cervical spine (C7 vertebra) with spinal cord compression. Management: Involved field radiotherapy, temozolomide, opioids, gabapentin, corticosteroids, and Cyberknife® therapy.