Dural-based melanoma metastasis mimicking a posterior fossa meningioma: A case report and review of the literature

Background: Intracranial metastases are a common complication in patients with systemic cancer; however, dural-based metastatic tumors represent a rare subset. To the best of our knowledge, only a limited number of cases of melanoma brain metastases mimicking meningiomas have been reported in the literature. We describe a case of a posterior fossa dural-based melanoma metastasis and review relevant literature from the past 10 years. Case Description: A 41-year-old woman with a history of the left eye enucleation due to intraocular melanoma, without regular medical follow-up, presented with a 4-month history of localized occipital headache, followed by progressive dizziness and lower limb incoordination. Magnetic resonance imaging revealed a dural-based posterior fossa lesion at the foramen magnum with radiological features highly suggestive of a meningioma. The patient underwent complete surgical resection, and histopathological analysis confirmed metastatic melanoma. Adjuvant treatment consisted of radiotherapy and immunotherapy with ipilimumab. Conclusion: Dural-based melanoma metastases may closely mimic meningiomas both clinically and radiologically, posing a significant diagnostic challenge. Surgical management is indicated in symptomatic cases, particularly those associated with mass effect or focal neurological deficits. Adjuvant radiotherapy and immunotherapy remain important components of treatment.