A Case of Malignant Melanoma of the Uterine Cervix with Disseminated Metastases throughout the Vaginal Wall

Abstract

Malignant melanoma (MM) in the female genital tract accounts for less than 2% of all melanomas, and the vast majority associated occur in the vulva and vagina. Primary MM of the uterine cervix is extremely rare and its prognosis is very poor. We report a case of primary MM of the cervix with dissemination throughout the vaginal wall. A 66-year-old woman presented with postmenopausal bleeding. Gynecologic examination demonstrated a 2 cm polypoid blackish-pigmented tumor on the cervix with multiple small blackish-pigmented lesions throughout the vaginal wall. Cervical Pap smear cytology showed malignant melanoma. MRI and PET/CT did not detect any distant or lymph node metastases. She underwent radical hysterectomy, pelvic lymphadenectomy, and total vaginectomy. The pathological diagnosis was FIGO stage IIIA primary cervical MM. She received adjuvant chemotherapy with 6 courses of dacarbazine, but 6 months later, multiple lung metastases were detected. Despite 4 courses of anti-PD-1 antibody (nivolumab) treatment, she died of the disease 13 months after surgery.

Primary malignant melanoma of the uterine cervix or vagina which were successfully treated with nivolumab

“…The immunotherapy includes PD‐L1 antibodies (nivolumab and pembrolizumab) and CTLA‐4 antibody (ipilimumab). Some articles have reported on the efficacy of nivolumab in primary cervical and vaginal MM . There are no randomized clinical trials that specifically address the activity of these agents as it relates to mucosal MM; however, some retrospective analyses have shown their benefits.…”

Primary malignant melanoma of uterine cervix in a young female - Report of a rare case

“…Spread to rectum, urinary bladder and urethral tube occurs commonly and pattern of lymphatic metastasis is usually similar to that of carcinoma cervix. 16 Available literature about primary mm of cervix is mostly in the form of single case reports and a few recent case series. [16][17][18][19][20] At present there is no consensus on the treatment of cervical melanoma.…”

“…16 Available literature about primary mm of cervix is mostly in the form of single case reports and a few recent case series. [16][17][18][19][20] At present there is no consensus on the treatment of cervical melanoma. Recommended therapeutic regimens for cervical melanoma include radical hysterectomy with pelvic lymph node dissection followed by radiation therapy, either intracavitary or external beam radiation or both.…”

Melanoma of the lower female genital tract (vulva, vagina, and cervix): literature review and own cases

“…Для диагностики заболевания необходимы гинекологический осмотр, дерматоскопия для меланом вульвы, кольпоскопия для меланом шейки матки, исследование мазков-отпечатков, биопсия или тонкоигольная аспирационная биопсия [31].…”