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Kechagias KS, Zafeiri M, Katsikas Triantafyllidis K, Kyrtsonis G, Geropoulos G, Lyons D, Burney Ellis L, Bowden S, Galani A, Paraskevaidi M, Kyrgiou M. Primary Melanoma of the Cervix Uteri: A Systematic Review and Meta-Analysis of the Reported Cases. Biology 2023; 12:biology12030398. [PMID: 36979090 PMCID: PMC10045237 DOI: 10.3390/biology12030398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Primary malignant melanoma (MM) of the cervix uteri is a rare and aggressive malignancy of the female reproductive tract. Considering that clinical data on this cancer are scarce, we aimed to comprehensively examine the currently available literature and provide an overview of the reported cases of cervical MM focusing on the clinical characteristics, diagnosis and therapeutic management. We conducted a systematic review of the literature by screening three electronic databases until June 2022. The critical appraisal checklist provided by the Joanna Briggs Institute was employed to evaluate the overall quality of the studies. We included 96 reports, which comprised 137 patients diagnosed with MM of the cervix. The mean age of the patients was 56.5 (median: 58, age range: 33–88). Data regarding menopausal status were provided for 98 patients with 15 being premenopausal and 83 being postmenopausal. The most common presenting symptom was vaginal bleeding (83%, 100/121). Biopsy (either excisional or punch biopsy) was used as the first diagnostic modality in most of the patients (67%, 64/95), followed by cytology (18%, 17/95). In 74 cases, the FIGO staging system for cervical cancer was used with the most common stage being FIGO stage I (38%, 28/74), followed by FIGO stage II (36%, 27/74), FIGO stage III (19%, 14/74) and FIGO stage IV (7%, 5/74). Most of the patients were managed surgically (90%, 119/131) with a hysterectomy (either radical or total), and a salpingo-oophorectomy with/without lymphadenectomy was the most common approach utilized (40%, 48/119). The data of clinical outcomes were provided for 105 patients, of whom 61 died (58%, 61/105) and 44 survived (42%, 44/105). Knowledge regarding the rare occurrence of MM in the cervix and the increased awareness of clinicians can prevent clinical misdiagnosis and ultimately improve further the clinical outcomes of patients developing this rare malignancy.
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Affiliation(s)
- Konstantinos S. Kechagias
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- Correspondence: ; Tel.: +44-7590803194
| | - Marina Zafeiri
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Konstantinos Katsikas Triantafyllidis
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of Nutrition and Dietetics, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Georgios Kyrtsonis
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of General Surgery, Croydon University Hospital, Croydon, London CR7 7YE, UK
| | - Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Deirdre Lyons
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Laura Burney Ellis
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Sarah Bowden
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Apostolia Galani
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Maria Paraskevaidi
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Maria Kyrgiou
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Min A, Fu A, Huang M, Wang H, Chen H. Primary Malignant Melanoma of the Cervix: An Integrated Analysis of Case Reports and Series. Front Oncol 2022; 12:913964. [PMID: 35814437 PMCID: PMC9258497 DOI: 10.3389/fonc.2022.913964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Melanoma, also known as malignant melanoma, is a type of malignant tumour that originates from melanocytes in the basal layer of the epidermis. Primary malignant melanomas of the female genital tract are rare. Similarly, primary malignant melanoma of cervix, which originates from cervical melanocytes, is an extremely rare disease and the second most common type of female melanoma in women aged between 15 to 44 years worldwide. To date, primary malignant melanoma of the cervix is characterized by poor patient prognosis and little consensus exists regarding the best treatment therapy. The situation is worsened by lack of clinical studies with large samples. Notably, surgery remains the preferred treatment option for patients with primary malignant melanomas of the cervix. Current treatments are based on Federation International of Gynecology and Obstetrics(2018) staging with reference to National Comprehensive Cancer Network guidelines. This study is in order to find a more suitable treatment modality for primary malignant melanoma of cervix. Therefore, we first conducted an integrated analysis of case reports and series to assess the impact of various factors on the prognosis of such patients. In summary, this is the first pooled analysis including 149 cases of primary cervical melanoma. We found that patients who underwent radical hysterectomy-based surgery, those with non-metastatic lymph nodes and those who underwent lymphadenectomy had significantly higher survival rates. In patients who had RH-based surgery, survival rates at the 24m time point of those who did not add other treatments was higher than those who did, but for those who had total hysterectomy-based surgery, the addition of other treatments to prolong median survival may be considered. In the overall analysis, age and lymphadenectomy were associated with increased and reduced risk of death in these patients, respectively. Although there is no statistical difference, stage III&IV, TAH, lymphatic metastases increase the risk of death; whereas radical hysterectomy was associated with reduced risk of death. In the subgroup analysis, for patients who have undergone radical hysterectomy-based surgery, lymphadenectomy reduces the risk of death, while lymphatic metastases and complementary other treatments increase the risk of death. For patients who have undergone total hysterectomy-based surgery, complementary treatment reduces the risk of death. In conclusion, via summarizing previous reports, the recommended treatment procedure for PMMC are radical hysterectomy and lymphadenectomy. The addition of other treatment options for patients who undergoing RH-based surgery need further study.
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Affiliation(s)
- Aiping Min
- Department of Obstetrics and Gynecology, People’s Hospital of Leshan, Leshan, China
| | - Aizhen Fu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Meiyuan Huang
- Department of Pathology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Hongjing Wang
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huan Chen
- Department of Obstetrics 1, Zhuzhou Central Hospital, Zhuzhou, China
- *Correspondence: Huan Chen,
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Diakosavvas M, Fasoulakis ZN, Kouroupi M, Theodora M, Inagamova L, Tsatsaris G, Nikolaou P, Frangia-Tsivou K, Giatromanolaki A, Kontomanolis EN. Primary Malignant Melanoma of the Cervix: A Case Report and a Review of the Literature. Case Rep Oncol Med 2020; 2020:7206786. [PMID: 33628550 DOI: 10.1155/2020/7206786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Gynecologic melanomas are extremely rare malignancies, and primary malignant melanoma of the cervix (PMMC) is the rarest among them all, with less than 100 cases reported so far. Although some conditions have been correlated with the pathogenesis of this entity, no specific risk factor has been yet identified, with vaginal bleeding being the most common symptoms. The diagnosis is based on physical examination with speculum assessment and cytologic and histopathologic findings accompanied with immunohistochemical staining of lesion's biopsies. Case Presentation. We report a case of PMMC in a 34-year-old para-2 patient, among the youngest cases of PMMC reported, that presented to our clinic for routine examination. Gynecologic examination demonstrated a dark, heavily fully pigmented cervical growth completely covering the entire external cervical os. Biopsy obtained and showed malignant melanoma. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The pathological diagnosis was FIGO stage IB1 PMMC. Despite 2 courses of anti-PD-1 antibody (Nivolumab) treatment, the patient passed away 13 months after diagnosis (12 months after surgery). Conclusions Early diagnosis and subsequently early treatment are of high importance regarding patients' prognosis and survival. No standardized protocols or treatment guidelines specific for this rare cancer have been issued; thus, clinicians are called to assess each case individually. Current treatment options are based on surgical excision mostly with radical hysterectomy, but in advanced or recurrent state of the disease, other treatment modalities, such as chemotherapy, radiotherapy, and immunotherapy, can be employed. Prognosis for these patients is very poor, and survival rate remains extremely low, with the median OS reported being less than 2 years. Reporting and publishing of such cases are both of paramount importance for the better understanding of this uncommon cervical malignancy, and further biological and clinical investigations are required for more suitable and effective therapies to be determined. A new staging system, specific to PMMC, could be of great use for the better correlation of the disease's stage and prognosis of these patients.
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Pumpure E, Dručka E, Kigitoviča D, Meškauskas R, Isajevs S, Nemiro I, Rasa A, Olmane E, Zablocka T, Alberts P, Doniņa S. Management of a primary malignant melanoma of uterine cervix stage IVA patient with radical surgery and adjuvant oncolytic virus Rigvir ® therapy: A case report. Clin Case Rep 2020; 8:1538-1543. [PMID: 32884791 PMCID: PMC7455402 DOI: 10.1002/ccr3.2928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 02/03/2023] Open
Abstract
Primary malignant melanoma of the uterine cervix is a rare disease with poor prognosis and high recurrence rate. We used Rigvir® as adjuvant therapy for a stage IVA patient. Tolerability, overall and progression-free survival are good.
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Affiliation(s)
- Elizabete Pumpure
- Department of Obstetrics and GynaecologyRiga Stradiņš UniversityRigaLatvia
- Riga Maternity HospitalRigaLatvia
| | - Eva Dručka
- Department of Internal DiseasesRiga Stradiņš UniversityRigaLatvia
| | - Dana Kigitoviča
- Department of Internal DiseasesRiga Stradiņš UniversityRigaLatvia
| | - Raimundas Meškauskas
- National Center of PathologyAffiliate of Vilnius University Hospital Santaros KlinikosVilniusLithuania
| | - Sergejs Isajevs
- Centre of PathologyRiga Eastern Clinical University HospitalRigaLatvia
- Department of PathologyFaculty of MedicineUniversity of LatviaRigaLatvia
| | - Ineta Nemiro
- Department of Diagnostic RadiologyOncology Centre of LatviaRigaLatvia
| | | | - Evija Olmane
- Department of RadiologyPauls Stradiņš Clinical University HospitalRigaLatvia
| | - Tatjana Zablocka
- Centre of PathologyRiga Eastern Clinical University HospitalRigaLatvia
- Department of PathologyFaculty of MedicineUniversity of LatviaRigaLatvia
| | | | - Simona Doniņa
- Oncology Centre of LatviaRiga East University HospitalRigaLatvia
- Institute of Microbiology and VirologyRiga Stradiņš UniversityRigaLatvia
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Shokrani M. Evaluation of 6 Patients with Genital Melanoma from Onset of Symptoms to Death: Evaluate the Factors Affecting the Prognosis of the Disease. Med Arch 2015; 69:293-7. [PMID: 26622079 PMCID: PMC4639327 DOI: 10.5455/medarh.2015.69.293-297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/15/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Genital melanoma is a rare but deadly cancer in women and the prognosis is often poor. Purpose: This study assesses the impact of possible risk factors on the end prognosis of the patients, with the ultimate goal of improving survival of disease. Methods: This is a report of 6 patients diagnosed and treated as genital melanoma. Parameters reviewed included: age at diagnose, presenting symptoms, location size and Breslow depth of lesion, stage at diagnose, adjuvant therapies, hysterectomy and salpingo-oophorectomy, metastasis or recurrence in follow-up, chemotherapy for metastatic disease. Results: The mean age at the time of diagnosis, was 44.67 years, the average size of lesion was 2.91 cm; the average Breslow depth of lesion was 1.93 mm. The mean interval between the onsets of symptoms to diagnosis was 16.7 months; the average life expectancy was 23.5 months. There is no significant relationship between the initial location of the lesion and prognosis (P: 0.98). Patients diagnosed in < 7 months, were in lower stages at diagnose (P: 0.018), and the survival of them was better (P: 0.035). Patients diagnosed in early stages had better survival at last (P: 0.035) Adjuvant radiotherapy improves survival markedly (P: 0.018). Hysterectomy and salpingo-oophorectomy had no significant effect on prognosis (P: 0.7). Chemotherapy in metastatic disease had no significant effect on prognosis (P: 0.46). Conclusion: The survival markedly improved if the disease diagnosed in a short distance from onset of symptoms and specially in early stages. Adjuvant radiotherapy can improve the survival significantly, but for the early hysterectomy and salpingo-oophorectomy and also for chemotherapy in metastatic disease, the impact on prognosis is uncertain, but positive.
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Affiliation(s)
- Marjan Shokrani
- Department of Surgery, Imam Khomeini Hospital, Department of Surgery, Valiasr Hospital, Department of Chemotherapy and Radiotherapy, Cancer Hospital, Tehran university of Medical Sciences, St. Gharib, Tehran, Iran
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Myriokefalitaki E, Babbel B, Smith M, Ahmed A. Primary malignant melanoma of uterine cervix FIGO IIa1: A case report with 40 months ongoing survival and literature review. Gynecol Oncol Case Rep 2013; 5:52-4. [PMID: 24371697 PMCID: PMC3862332 DOI: 10.1016/j.gynor.2013.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/15/2013] [Indexed: 11/28/2022]
Abstract
Primary malignant melanoma of cervix is an extremely rare neoplasm and regardless stage and treatment, prognosis is extremely poor. The only available primary treatment that improves prognosis is radical surgical excision of the tumor with wide clear margins.
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Affiliation(s)
- E. Myriokefalitaki
- University Hospitals of South Manchester, Manchester, UK
- University Hospitals of Leicester, Leicester, UK
- Corresponding author at: University Hospitals of Leicester, Leicester, UK.
| | - B. Babbel
- University Hospitals of South Manchester, Manchester, UK
| | - M. Smith
- University Hospitals of South Manchester, Manchester, UK
| | - A.S. Ahmed
- University Hospitals of South Manchester, Manchester, UK
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Pusceddu S, Bajetta E, Carcangiu ML, Formisano B, Ducceschi M, Buzzoni R. A literature overview of primary cervical malignant melanoma: an exceedingly rare cancer. Crit Rev Oncol Hematol 2011; 81:185-95. [PMID: 21515070 DOI: 10.1016/j.critrevonc.2011.03.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/03/2011] [Accepted: 03/24/2011] [Indexed: 11/25/2022] Open
Abstract
Primary malignant melanoma (MM) of the uterine cervix is an extremely rare neoplasm, with about 78 cases described in the literature. Since traces of melanocytes in normal cervical epithelium were found in 3.5% of cases primary origin of melanoma at this site cannot be ruled out. It occurs mainly in the sixth decade of life, and it is five time less common than primary vaginal or vulvar MM. Clinical history usually includes abnormal genital bleeding; and physical examination frequently reveals a pigmented, exophytic cervical mass. Diagnosis is confirmed by immuno-histochemical methods and by exclusion of any other primary site of melanoma. Treatment of this condition is not yet standardized, and the overall prognosis is very poor. Diagnostic approaches and therapeutic procedures on primary MM of the uterine cervix are discussed following a review of the literature encompassing more than one century.
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Affiliation(s)
- Sara Pusceddu
- Medical Oncology Unit 2, Department of Pathology, Anatomic Pathology A Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via G. Venezian 1, 20133 Milan, Italy
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Boldt C, Lehmann R, Osmers R, Bürrig KF. [Primary malignant melanoma of the uterine cervix. Report of two cases and review of the literature]. Pathologe 2003; 24:226-35. [PMID: 12739058 DOI: 10.1007/s00292-002-0596-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The manifestation of a malignant melanoma in the uterus is very rare, more often it is the result of metastasis rather than a primary tumor. A malignant melanoma at this site can originate either from melanocytic elements within the cervical epithelium or from the cervical stroma. We report on two cases of primary malignant melanoma of the uterine cervix and compare them with other cases from the literature.
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Affiliation(s)
- C Boldt
- Institut für Pathologie, Städtisches Krankenhaus Hildesheim GmbH, Hildesheim
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