Primary Intraparenchymal Solitary Malignant Melanoma of the Brain Without Dural Attachment: A Rare Case With Local Recurrence.

Malignant melanoma is a neoplasm arising from the malignant transformation of melanocytes. These cells are derived from the neural crest and are found predominantly in the skin, but also in mucous membranes, the uveal tract of the eye, the leptomeninges, and other sites. A 39-year-old previously healthy male presented with a holocranial headache for two months and a single episode of a focal seizure involving his left arm. Neurological exam revealed left-sided pronator drift and gross papilledema. Contrast-enhanced magnetic resonance imaging (CE-MRI) of the brain revealed a large (4.8 x 3.9 cm) heterogeneously enhancing lesion in the right parieto-occipital region with marked perilesional edema, with the provisional diagnosis of a high-grade lesion. Complete metastatic work-up, including computerized tomography (CT) of the chest and abdomen and positron emission tomography (PET), revealed no primary lesion; hence, the lesion was planned for excision. Gross total excision (GTE) was achieved, and histopathological examination (HPE) of the resected specimen confirmed malignant melanoma. Recurrence was noted 11 months later with an even bigger lesion (6.0 x 5.0 cm) on CE-MRI, and the patient succumbed to death 45 days later under the care of oncology for adjuvant chemotherapy. Primary intracerebral malignant melanomas are extremely rare tumours of the CNS. Despite surgical and chemotherapeutic treatment options, these tumours are a clinical ordeal due to their aggressive behaviour and explosive growth rate. The primary existence of melanoma intracerebrally is an oncologic enigma and needs to be included in the differential diagnosis of primary brain lesions.