House, HannaArcher, JacobBradbury, Jamie2023-09-052023-09-052021-11-15House H, Archer J, Bradbury J. Primary spinal melanoma: illustrative case. J Neurosurg Case Lessons. 2021;2(20):CASE21542. Published 2021 Nov 15. doi:10.3171/CASE21542https://hdl.handle.net/1805/35354Background: Primary spinal melanoma is extremely rare, accounting for ∼1% of all primary melanomas. Typically presenting insidiously in the thoracic spinal cord, primary spinal melanomas can have an acute presentation due to their propensity to hemorrhage. Observations: Despite its rarity, primary spinal melanoma should be included in the differential diagnosis when a hemorrhagic pattern of T1 and T2 intensities is seen on magnetic resonance imaging. Furthermore, the complete diagnosis is crucial because the prognosis of a primary spinal melanoma is considerably more favorable than that of a primary cutaneous melanoma with metastatic spread. Lessons: Resection is the treatment of choice, with some authors advocating for postoperative chemotherapy, immunotherapy, and/or radiation. We describe a case of acute quadriplegia from hemorrhagic primary spinal melanoma requiring resection.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalSpinal melanomaIntradural tumorSpinal oncologyArticle