[The primary melanoma of the female genital tract: report of three cases and review of literature]

Primary Malignant Melanoma of the Vagina without Metastasis: A Rare Case and Review of Literature

Malignant melanoma of vagina is a rare condition. Its histogenesis has been debated and the positive diagnosis is based on immunohistochemistry. Pelvic magnetic resonance imaging remains the gold standard for assessing locoregional extension status and post-treatment surveillance of melanoma of vagina. The observation concerned a 53-year-old woman with no specific history who presented a primary malignant melanoma of vagina without secondary locations. To date, the case is the second one reported in the literature. Early diagnosis of the malignant melanoma of vagina may improve patient survival because late diagnoses are punctuated by poor prognosis. We have presented epidemiological with etiopathogenic characteristics and described all imaging features to stage the tumor and to conduct the appropriate treatment.

[Case study of vulvar malignant melanoma conducted at the Cinquantenaire General Hospital in Lubumbashi]

Le mélanome malin primitif de l'appareil génital féminin est une tumeur extrêmement rare. Il est néanmoins plus observé à la vulve qu’au col utérin et au vagin. La localisation vulvaire représente environ 1% (toutes localisations confondues) des mélanomes, puis par ordre de fréquence la localisation vaginale, utérine puis ovarienne; et moins de 200 cas de cancers de la vulve ont été décrits à travers le monde. Nous présentons ici un cas clinique de mélanome malin vulvaire chez une femme ménopausée de 72 ans. Une hemivulvectomie partielle et une lymphadénomectomie superficielle inguinale bilatérale ont été réalisées. Les suites postopératoires étaient globalement favorables et la patiente a quitté le service au 15^e jour post opératoire.

Combined immunotherapy and radiation for treatment of mucosal melanomas of the lower genital tract

OBJECTIVE

To report our experience using ipilimumab, a monoclonal antibody targeting CTLA-4, combined with radiation therapy in women diagnosed with mucosal melanoma of the lower genital tract.

METHODS

We retrospectively identified all patients who received ipilimumab with concurrent radiation treatment of mucosal melanoma of the lower genital tract at Memorial Sloan Kettering Cancer Center from 2012 to 2015. Various clinicopathologic data and treatment response were abstracted and analyzed.

RESULTS

Four patients were identified. Median age was 61.5 years (range 44-68); 3 were diagnosed with vaginal melanoma, 1 with cervical melanoma. All would have required extensive surgical procedures to remove entirety of disease. Median size of lesions was 4.7 cm (range, 3.3-5.3); all were Ballantyne stage I. Median number of doses of upfront ipilimumab was 4 (range, 3-4). Two patients suffered CTCAE grade 3 adverse events (colitis, rash). All received external beam radiation: 3 to 3000 cGy, 1 to 6020 cGy. Post-radiation surgical resection was performed in 3 patients (75%); 1 (33%) of 3 patients achieved complete pathologic response. Complete local radiographic response was observed in all patients after completion of initial therapy and surgery. Two developed recurrence at 9 and 10 months post-diagnosis (mediastinum, lung); 2 remain disease-free at 20 and 38 months.

CONCLUSIONS

Mucosal melanoma of the lower genital tract is rare, and data-driven treatment strategies limited. Immunotherapy has demonstrated durable efficacy in the treatment of cutaneous melanomas. Our small case series shows a favorable response to combined ipilimumab and radiation therapy. Larger studies are needed to validate these promising results.