This 46 y/o female was referred for evaluation of headache and memory loss. Images from her non-contrast enhanced CT and her pre and post gadolinium MRI are shown above. There is a high CT attenuation lesion in the supra sellar region which has heterogeneous enhancement after the administration of gadolinium. After stereotactic needle biopsy, subsequent resection, extensive pathologic evaluation and consultation, and follow up a diagnosis of leptomeningeal melanoma was made. Argument arose as to whether this was a primary leptomeningeal melanoma or a late metastasis as on further questioning the patient recalled removal of a skin lesion 15 years prior to presentation. Pathology of that skin lesion was not available.
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