A 58-year-old man suffered from limb weakness and unsteady walking due to a rare melanoma invading his brain!

Mr. Wu, 58 years old, from Yueyang, Hunan, felt weakness in his right limbs and unsteady walking for the past three days. He thought it was due to his old age and his hands and feet were not as nimble as before. However, as the symptoms gradually worsened, Mr. Wu began to feel dizzy and could not even walk alone. He then went to a local doctor. A head MRI showed a space-occupying lesion in the left frontal lobe, which was initially suspected to be a hemangiopericytoma.

Ordinary people would never know the word "tumor". The family members were immediately shocked. Based on the recommendation of relatives and friends, they came to the Department of Neurosurgery II of Hunan Provincial Second People's Hospital (Provincial Brain Hospital) to see Dr. Li Xin, chief physician .

Chief Physician Li Xin learned through detailed medical history that Mr. Wu had undergone surgery, radiotherapy and chemotherapy for maxillary melanoma 6 years ago. Based on imaging data and past medical history, the department discussed preoperatively that metastatic melanoma was likely the cause.

Unexpectedly, after admission, Mr. Wu's condition worsened further, and the muscle strength of his right limbs continued to deteriorate, with the muscle strength of his right upper limb at level 0 and that of his right lower limb at level I. In order to better promote the functional recovery of the affected limbs, after fully communicating with Mr. Wu's family, Chief Physician Li Xin's team arranged an emergency operation the next day after admission to relieve the compressive damage of the tumor to the local brain tissue as soon as possible.

After sufficient preoperative preparation, Chief Physician Li Xin and Chief Physician Xie Zhimin's team performed an emergency left frontal lobe mass craniotomy on Mr. Wu. The tumor was successfully removed during the operation. After the operation, Mr. Wu was transferred to the neurosurgery intensive care unit for further treatment.

One week after the operation, Mr. Wu's right limb muscle strength had improved significantly. The muscle strength of his right upper limb reached level II, and the muscle strength of his right lower limb reached level III. However, this was only the first step in his treatment. The postoperative pathological examination suggested metastatic melanoma, which was the same as the preoperative discussion. He will receive further radiotherapy and chemotherapy in the future.

Chief Physician Li Xin said that although melanoma does not have the word "cancer" in its name, it is one of the most malignant tumors in the brain. 91% of melanomas originate from the skin, among which intracranial metastatic melanoma is a type with a low incidence, high misdiagnosis rate and poor prognosis.

Due to the lack of relevant characteristics of typical neurosurgical diseases, in addition to focal neurological deficits caused by different lesion sites, chronic symptoms of increased intracranial pressure such as headache, nausea, vomiting, etc. may also occur. Due to bleeding from intracranial metastatic lesions, acute intracranial pressure increase, brain herniation and epileptic seizures may also occur.

Hunan Medical Chat Special Author: Li Yanni, Department of Neurosurgery II, Hunan Second People's Hospital (Provincial Brain Hospital), Guo Fa, Department of Science and Education

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(Edited by YT)