Surgical treatment of vaginal and vulvar melanoma: a 18-year retrospective study

Vaginal and vulvar melanomas are rare and seems to have extremely poor prognosis, often diagnosed with locally advance stage, with difficulties to obtain free surgical margin. The aim of this study was to describe long term outcomes of vaginal and vulvar melanomas after surgical treatment.

Retrospective observationnal cohort study between January 2002 and december 2020 at Gustave-Roussy Institute.

A total of 57 patients were treated for vulvar and vaginal melanoma between january 2002 and december 2020. Among them 38.6 % (22/57) had surgery for vaginal (10/22) or vulvar melanoma (12/22). The main symptoms at diagnosis were vaginal bleeding for 40.9 % (n = 9/22), and vaginal mass for 36.4 % (n = 8/22) of the patients. Median tumor size was 15 mm (10-30). Free margins was obtained in 55.5 % of the cases (n = 12/20). Mutation (c-KIT, BRAF, NRAF) were found in 27 .3 % of the patients (6/22). Median progression free survival was 7.5 (5-11) months and overall survival 24 (12-41) months.

Vaginal and vulvar melanoma have a poor prognosis. Extensive surgery with anterior or posterior pelvectomy shoud only be performed to obtained free margin with caution in well selected patient. Radiological lymph node should contraindicate primary surgical strategy. Neodjuvant immunotherapy could help to obtained free margin in patient with high risk of invaded margin, these patients should be included in randomized controlled clinical trials.