Author: Poppy Brown, Muhammad Huzaifa Ameer / Editor: Stephen Sheridan / Codes: / Published: 23/08/2026
A 52-year-old female presents to the emergency department (ED) with a 3-week history of migratory back pain following a long car journey. The pain initially affected the thoracic spine before progressing to the lumbar region. She now reports left-sided sciatic pain with numbness affecting the lateral three toes and left labia majora.
She denies bladder or bowel dysfunction. The pain is present at rest and on movement. She has previously attended twice with similar symptoms but has not undergone imaging. She has seen a chiropractor, who has suggested a diagnosis of a prolapsed intervertebral disc.
Her past medical history includes health anxiety. She takes co-codamol and naproxen as required. She has no known allergies and is normally fit and well, working as a teacher.
On examination, she mobilises independently but with difficulty due to pain. There is reduced sensation in the L5/S1 distribution (lateral three toes and lateral plantar foot) and S2 distribution (left labia majora). Power and reflexes are normal in both lower limbs.
Given concern for cauda equina syndrome, an urgent MRI of the whole spine is performed. This demonstrates extensive skeletal metastases with a pathological T6 fracture and cord encroachment, alongside suspected lung malignancy. No cord compression is identified.
Further CT imaging reveals widespread metastatic disease involving lungs, liver, and bone, with a likely primary lung lesion. A hypervascular buttock lesion is biopsied and confirms BRAF-mutant metastatic melanoma. The patient is commenced on radiotherapy and targeted therapy but dies six months later.
