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Published on: June 7, 2019
Management of melanomas of the female genital tract
Valerie E Sugiyama1, John K Chan, Daniel S Kapp
1Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, Stanford, CA 94305-5847, USA.
Purpose Of Review:
The significant increase in cutaneous melanomas over the past 30 years has led to studies resulting in advances in their diagnosis, staging, surgical treatment, and adjuvant therapies. Similar approaches have been investigated in patients with far rarer malignant melanomas of the female genital tract. This review will summarize the current state of knowledge on the incidence, causes, presenting symptoms, prognostic factors, therapeutic approaches, and outcomes, site-by-site, for primary melanomas of the vulva, vagina, urethra, ovary, and the uterine cervix.
Recent Findings:
Surgery remains the initial treatment of choice for localized melanomas of the female genital tract, with less radical, organ function preserving resections demonstrating similar control rates compared with more radical surgical approaches in vulva and possibly vaginal melanomas. Radiation therapy may play a role in the treatment of patients with close resection margins, regional nodal metastasis, or unresectable tumors. Sentinel lymph node studies, positron emission tomography and computed tomography scans for staging and evaluation of response, and adjuvant chemo or biochemotherapy warrant further investigation.
Summary:
The results of treatment for female genital tract melanomas remain poor. Although surgery remains the initial treatment of choice for localized disease, adjuvant local-regional, and systemic therapies are needed.
Insights
Malignant melanomas of the female genital tract are rare but have poor treatment outcomes. Surgery is the primary treatment for localized disease, but novel adjuvant therapies are crucial for improving survival rates.
Area of Science:
- Gynecologic Oncology
- Dermatology
- Surgical Oncology
Background:
- Cutaneous melanoma incidence has risen significantly, prompting advances in diagnosis and treatment.
- Malignant melanomas of the female genital tract are rare, necessitating specific research into their management.
- This review synthesizes current knowledge on female genital tract melanomas.
Purpose of the Study:
- To review the incidence, causes, symptoms, prognostic factors, and treatment outcomes of primary melanomas affecting the vulva, vagina, urethra, ovary, and cervix.
- To provide a comprehensive overview of the current state of knowledge for these rare malignancies.
Main Methods:
- Literature review summarizing existing studies on female genital tract melanomas.
- Site-by-site analysis of incidence, etiology, clinical presentation, and therapeutic approaches.
- Evaluation of prognostic factors and treatment outcomes.
Main Results:
- Surgery is the primary treatment for localized female genital tract melanomas.
- Organ-sparing surgical techniques show comparable outcomes to radical resections for vulvar and vaginal melanomas.
- Radiation therapy may benefit patients with positive margins or nodal metastasis.
Conclusions:
- Treatment outcomes for female genital tract melanomas remain suboptimal.
- While surgery is the cornerstone of initial treatment, effective adjuvant therapies are essential.
- Further research into sentinel lymph node biopsy, advanced imaging, and chemo/biochemotherapy is warranted.
