A case of cervical juxtamedullary meningeal melanocytoma is presented
along with results of careful neuroradiological and pathological exami
nations. The authors review the previous literature and discuss the pr
oblems related to the intriguing diagnosis of this very rare entity CT
and MRI show variable appearances due to different degrees of melaniz
ation and do not reliably allow us to distinguish meningeal melanocyto
mas from other pigmented tumors. Pathological examination of the tumor
is critical for diagnosis, but it absolutely must comprise electron m
icroscopy and immunohistochemistry. Immunohistochemical and ultrastruc
tural criteria are thus proposed to distinguish meningeal melanocytoma
from pigmented meningioma or schwannoma and malignant melanoma (prima
ry or secondary).