Vaginal melanoma and the role of regional chemotherapy

Malignant melanoma of the vagina: A case report and review of the literature

Primary malignant melanoma of the vagina is an extremely rare variant of melanoma that accounts for <3% of all vaginal malignancies. Primary malignant melanoma of the vagina has a worse prognosis as compared with non-genital melanomas or other vaginal malignant neoplasms. A-35-year-old female had a diagnosis of primary malignant melanoma of the vagina. A local excision of the tumor was first performed, followed by a radical excision as a further therapeutic measure. The patient returned after three weeks, presenting with a vesico-vaginal fistula. A conservative operation was subsequently performed in order to improve the quality of life of the patient. Pelvic metastases were identified 6 months after the completion of the last surgical therapy and subsequent follow-up examinations were performed in another hospital. The present case study describes the clinical features and surgical procedures of this patient with primary malignant melanoma of the vagina. In conclusion, melanoma of the vagina is an extremely aggressive cancer and the overall prognosis is poor despite the various treatment options.

Vaginal melanoma: a current review

Vaginal melanoma is rare, accounting for less than 3% of primary vaginal tumours. It principally affects postmenopausal women, however no risk factors have been identified. Patients frequently present with vaginal bleeding, but the tumour is locally advanced at presentation. Surgery is only the potential cure. The relative merits of radical surgery-vaginectomy and iliac or inguinal lymphadenectomy-versus wide local excision with prompt treatment of recurrences remains uncertain. High dose external radiotherapy and regional chemotherapy trials have been encouraging, although there is no definite survival advantage. Patients should be offered excisional therapy with the opportunity to participate in trials of adjuvant therapy. Prognosis is poor with a five-year survival of 5-21%. Effective screening measures are required enabling earlier diagnosis.

Primary malignant melanoma of the vagina

BACKGROUND

Primary vaginal melanoma is a rare, highly malignant, and poor prognostic disease.

CASE

The 51-year-old patient with diagnosis of vaginal malignant melanoma was referred to our clinic. Since detection of pervasive brown lesions in the vagina total vaginectomy was performed. At pathological investigation melanoma was not determined. Immunotherapy was administered adjuvantly. Paraaortic lymph node metastasis was seen on the ninth month after total vaginectomy and the metastatic lymph nodes were excised. Cisplatin and tremozolamide chemotherapy was administered for six cycles after surgery. The patient is alive and disease-free at 18th month of the diagnosis of the disease.

CONCLUSION

The impact of therapy on outcome of primary vaginal malign melanomas is poorly understood. Improved clinical outcomes were associated with surgical removal of gross disease whenever possible. Because of the low rate of lymph node metastasis, elective pelvic lymph node dissection is not mandatory. We presented a case of FIGO stage I primary vaginal malignant melanoma, which metastasized to the paraaortic lymph nodes 9 months after the primary operation.

Primary malignant vaginal melanoma treated with adriamycin and ifosfamide: A case report and literature review

BACKGROUND

Vaginal melanoma is a very rare but highly malignant gynecological disease, usually diagnosed in postmenopausal woman. The prognosis tends to be poor and it is associated with high rate of recurrence and short survival rates.

CASE

The following paper describes a case report regarding a 72-year-old woman with a locally advanced malignant melanoma. The previous erroneous histopathological diagnosis was leiomyosarcoma. She underwent chemotherapy with 3 courses of doxorubicin and ifosfamide. The diagnosis of malignant melanoma was obtained after a repeated biopsy and further pathological investigations. She later underwent radical surgery and 2 additional cycles of the same chemotherapy. At present, 7 months after the last cycle, the patient was locally disease-free, but developed brain metastases, requiring chemotherapy treatment.

CONCLUSION

In view of poor survival, this chemotherapy regimen may be an interesting alternative to the traditional treatment of vaginal melanoma.

Vaginal malignant melanoma: a case report and literature review

Vaginal melanomas are rare genital malignancies occurring mainly in the 6th and 7th decades of life. In general, they have a worse prognosis than cutaneous melanomas. In the past, various treatment modalities have been recommended including radical pelvic surgery. However, the prognosis is poor in spite of such radical approaches. More recently, more conservative treatment in the form of wide local excision combined with adjuvant chemotherapy, high-dose radiotherapy, and immunotherapy seem to have promising results. We describe a patient with vaginal malignant melanoma treated with conservative local excision as well as adjuvant radiotherapy, chemotherapy, and interferon.

Primary vaginal melanoma: thirteen-year disease-free survival after wide local excision and review of recent literature

OBJECTIVES

We present a case report of a woman who has survived 13 years after conservative treatment with wide excision for vaginal melanoma and review and evaluate the literature on this disease since the last metaanalysis in 1989.

STUDY DESIGN

A database literature search along with cross referencing from related articles uncovered 66 patients who were reported to have vaginal melanoma since 1989 with adequate information for our analysis. We add to this one original case reported by us. Where information was available, we analyzed outcomes on these cases on the basis of patient age, tumor thickness, tumor size, and treatment.

RESULTS

The patient we describe is only the eighteenth reported patient to survive vaginal melanoma 5 years and only the third to survive for 10 years. Of the 67 patients in our overall review, mean age at the time of diagnosis was 62 years. Patients with tumor size < 3 cm had a mean survival of 41 months compared with 12 months for those with tumor size > or = 3 cm (p < 0.0024). Tumor thickness did not significantly affect patient survival at any of the depths analyzed, although there was a tendency toward significance at depths > 8 mm (p < 0.0778). There also was no significant difference in patient outcome among five treatment groups: (1) wide excision, (2) radical surgery, (3) radiation therapy, (4) wide excision plus radiation therapy, and (5) other.

CONCLUSION

Tumor size appears to affect survival in patients with vaginal melanoma. Tumor thickness, at least at the levels at which vaginal melanomas are currently being diagnosed, does not seem to affect survival. Because no single treatment is clearly preferable, we suggest conservative resection where possible. We find it difficult to support radical surgery as primary treatment for vaginal melanoma unless necessary to achieve clear tumor margins. Radiation therapy appears to offer results comparable to those of surgery.