Severe cord compression due to unique extradural meningeal melanocytoma of intermediate grade

Background: Meningeal melanocytomas are rare primary melanocytic tumors of the leptomeninges estimated to occur in 1 out of 10 million patients. They typically arise intracranially or within the intradural extramedullary spinal canal, while extradural presentations are uncommon. Here, we present a 36-year-old male whose intermediate-grade lesion (i.e., containing features of both benign melanocytoma and malignant melanoma) caused extradural C6–T2 cord compression relieved with laminectomy/fusion. Case Description: A 36-year-old male presented with progressive right-hand paresthesias, weakness, intrinsic muscle atrophy, and forearm pain consistent with cervical radiculomyelopathy. The magnetic resonance imaging revealed a large right-sided extradural mass extending from C6 to T2 with marked cord compression. He underwent a C6–T2 laminectomy with instrumented fusion; gross total resection of the pigmented mass was achieved. The histopathology confirmed an intermediate grade meningeal melanocytoma. Postoperatively, serial surveillance imaging demonstrated no recurrence, and the patient regained full right-hand strength without adjuvant therapy. Conclusion: This case highlights the successful diagnosis and surgical management (i.e., with gross total removal) of an extradural intermediate-grade meningeal melanocytoma causing cervical radiculomyelopathy.