Malignant vulvo-vaginal melanoma: a report of 7 cases

To evaluate the clinical outcome of patients suffering from primary vulvo-vaginal malignant melanoma retrospective review of clinical and pathological data of six patients with vulvar malignant melanoma and one patient with vaginal melanoma was done. Patients were staged using the 1988 FIGO histological classification for vulvar cancer, and the 1992 American Joint Committee on Cancer (AJCC) classification for malignant melanoma of the skin. Clinical features, type of surgery, adjuvant therapy, recurrences, distant metastasis, and survival were recorded. Of 174 primary cancers of the vulva, six were malignant melanomas (3.4%), the second most common cause of vulvar cancer. Within the same period, only one primary vaginal melanoma was detected among 57 primary vaginal cancers (1.7%). The median age of all patients was 71 (range 61-84). We performed different surgical procedures, including a radical local excision of the lesion in the vaginal melanoma, a radical hemivulvectomy in one case, a radical vulvectomy in an other case, and a radical vulvectomy with lymph node dissection en bloc in three cases. According to the 1988 FIGO classification for vulvar carcinomas, three patients were diagnosed as stage I and four as stage III melanomas; and using the 1992 AJCC classification for malignant melanoma of the skin, all patients were staged as stage III. Two out of five patients, with a follow-up longer than two years, continued to live and were disease free at the last check-up (40%): the rest of them (60%) died of disease 2.9 months after the diagnosis of the distant metastasis. Vulvo-vaginal malignant melanomas are neoplasias with a very poor prognosis and a short period of time between the detection of distant metastasis and death. Although treatment is not clear in vaginal melanoma, the most accepted treatment in vulvar melanomas is the radical local excision of the lesion with a homolateral inguinofemoral lymphadenectomy.