Mucosal melanomas are rare in comparison to cutaneous melanomas, accounting for approximately 1% of all melanoma cases. Vulvovaginal melanoma is the least common mucosal melanoma subtype. For patients without distant metastases at presentation, regional lymph node involvement is the most important prognostic indicator. Lymphoscintigraphy is a method used to identify the sentinel lymph node (SLN), directing subsequent biopsies to the lymph node at highest risk for cancer spread. We present a 67-year-old Hispanic female with stage II B (T4aN0M0) melanoma of the clitoris. The patient initially sought medical treatment for a pigmented vulvar lesion over her clitoris that occasionally bleeds. She stated that over the past month the lesion began to grow peripherally and then acquired a very dark color. The patient underwent local excision of the mass and subsequent pathology revealed malignant melanoma. The patient underwent lymphoscintigraphy which allowed localization and subsequent biopsy of the left inguinal sentinel node. The left inguinal sentinel node was negative for metastatic melanoma. It was opted to keep her under observation. Compared to cutaneous melanoma, patients with mucosal melanoma usually present with more advanced disease, and thus efficacious imaging practices play a significant role in the management of the disease. Lymphoscintigraphy is a well-tolerated, validated, cost-effective, and reliable method of detecting sentinel nodes with minimal radiation exposure to the patient. In our case, early clinical detection allowed for prompt surgical intervention, pathologic diagnosis, and reliable staging via lymphoscintigraphy of a rare form of malignant melanoma.

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