Spine Metastasis of Conjunctival Melanoma: A Case Report

Case Report

Austin J Clin Case Rep. 2016; 3(2): 1092.

Spine Metastasis of Conjunctival Melanoma: A Case Report

Xue Y¹, Ma J2#, Liu X¹, Li H¹ and Fan H¹*

¹Department of Orthopaedic Surgery, Fourth Military Medical University, China

²State Key Laboratory of Cancer Biology & Institution of Digestive Disease, Fourth Military Medical University, China

#Author contributed to the work equally and should be regarded as co-first author

*Corresponding author: Hongbin Fan, Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, Xi’an, 710032, China

Received: May 26, 2016; Accepted: July 05, 2016; Published: July 12, 2016


Purpose: Conjunctival melanoma (CM) is rare in ocular melanomas, which often develop systemic metastasis. As the latent event of melanoma progression, bone metastasis is not common. The tumor with high invasion may result in the bone structure destruction, fracture occurrence, and motor dysfunction. Till now, there are few reports on bone metastasis of conjunctival melanoma.

Methods: A 53-year-old woman who had a backache and ribs pain for 6 months was diagnosed of multiple melanoma metastasis of spine. MRI indicated the metastasis tumor of T11-T12 spine and pathological fracture. The bone scan found disseminated mass radioactivity concentration points in spine, ribs, and limbs. Decompressive laminotomy was performed in T11-T12 to relieve pain and internal fixation in T9-L2 was taken to enhance the stability of spine.

Results: The pathology indicated that the metastasis of malignant melanoma in thoracic vertebrate. Immunohistochemistry staining revealed: HMB-45(+), Pan-mcl(+), S-100(+), CD117(+), NF(-), CD34(-), AE1/AE3(-), and Ki-67 incremental index (40%). The gene mutation report indicated that multiple mutations of C-KIT (N655D mutation), PDGFRA (L641P mutation), and NRAS (E31K mutation) gene. The gene target therapy (imatinib mesylate) was applied and showed satisfactory results.

Conclusion: This report described the incidence of bone metastasis of CM, which had a low survival rate and a poor prognosis. For timely diagnosis and effectively treatment, more detailed examinations should be considered to confirm whether there exists bone metastasis.

Keywords: Conjunctival melanoma; Spine metastasis; Pathological fracture


Although conjunctival melanoma (CM) is an uncommon malignancy with the incidence of 0.2 cases per million, it is a sightand life-threatening condition [1]. It represents approximately 1-2% of ocular melanoma and 1.6% of all non-cutaneous melanomas [2,3]. Despite the therapeutic advances in the treatment of CM, local recurrence rates are as high as 62% and mortality ranging from 18% to 44% [4]. Metastases can occur via lymphatics to regional lymph nodes and haematogenously to other parts of the body. Till now, there are few reports on bone metastasis of CM.

Case Presentation

A 53-year-old woman who had suffered severe back and ribs pain for 6 months was referred to our department in 2013. In 2000, she found a linear dark deposit in her left ocular conjunctiva diagnosed of “melanin deposit”. It developed and became a patch like deposit in 2008 (Figure 1A). Physical examination showed obvious kyphosis deformity. The tenderness sites could be found in T11-L2. The muscle strength of both lower limbs was normal and no pathologic reflex sign was observed. The plain film indicated the radiolucent lesions in T11 vertebrae and left 3 to 7 ribs. The sagittal T2-weighted MRI image indicated the multiple spine metastasis and pathological compression fracture in T11 (Figure 1B). The axial MRI image showed low signal lesion invaded nearly all the vertebral body and pedicles (Figure 1C). The PET-CT scan showed extensive increased uptake in spine, ribs, and limb bones (Figure 2A). CT scan showed a large osteolytic lesion involving nearly the whole vertebrae (Figure 2B). In addition, the level of tumor-related serum biomarkers including Lactate dehydrogenase and CA-199 increased.