Aggressive metastatic malignant melanoma of vagina: A case report

Abstract

Malignant melanoma is a rare neoplasm originating from skin and rarely, from mucosal membranes. Genital melanomas are a rare variant of the malignancy. Vulvar and vaginal malignant melanomas are the most common form of melanomas in the female genital tract. Vaginal malignant melanoma is a rare and aggressive neoplasm of the genital tract, presenting in the 5 th and 6 th decade and is associated with early dissemination and metastasis. It presents a diagnostic dilemma as it is confused with squamous cell carcinoma of vagina or cervix, hence, resulting in late diagnosis and poor prognosis. Vaginal melanomas differ from cutaneous melanomas in both pathology and molecular biology, with BRAF being detected in very few cases as opposed to cutaneous melanomas. We present a case of malignant melanoma of vagina which was extensively metastatic at diagnosis. It was initially diagnosed after a frontal craniotomy done for a space occupying lesion in the brain. Subsequently, multiple nodes were detected in axillary and inguinal regions. We treated her whole brain radiotherapy and then she was started with chemotherapy, paclitaxel and carboplatin. Her disease progression is stable and her KPS has improved with the treatment. High degree of clinical suspicion and a detailed gynaecological examination can help in early diagnosis and start of treatment. Complete surgical resection and radiotherapy, whenever possible should be done. A combination of chemotherapy and immunotherapy afterwards can control the disease progression in both localised and metastatic cases.

Primary Malignant Melanoma of the Vagina without Metastasis: A Rare Case and Review of Literature

“…There is also a possible implication of hormonal influence (puberty, pregnancy, menopause, and the use of oral contraceptives) and HPV in melanomas. 11 Recurrent genital infection, vaginal hysterectomy scar with repeated sexual trauma, immunity deficit as melanoma of vagina was antigenic tumor, family predisposition, and local precancerous lesions were the risk factors discussed in literature. 6 There were theories which proposed that KIT gene mutations which encode for a protein called c-KIT and are microenvironmental in nature are cited in pathogenesis and there is no relation with ultraviolet radiation.…”

“…3,4,17 Radiotherapy may have role either as an adjuvant following surgery or when surgery is not feasible due to the disease or patient-related factors. 5,11 Surgery, radiotherapy, and immunotherapy with interferon-α are the mainstay of treatment for localized disease, while chemotherapy with dacarbazine is mostly used for unresectable and recurrent disease. 4,17 Let us know that our case did not present secondary lesions which earned him his unusual presentation .The disease is associated with a high risk of local recurrence, distant metastases, and poor clinical outcome.…”

Melanoma Maligna Vagina: Laporan Kasus dan Tinjauan Literatur

“…16 Keterlibatan kelenjar getah bening pelvis dan/atau inguinal dilaporkan pada 25% hingga 50% kasus. 17 Lesi paling sering muncul dalam tipe hiperpigmentasi melanositik, meskipun mungkin juga dalam bentuk amelanotik. Sistem klasifikasi yang digunakan sesuai dengan Federasi Internasional Ginekologi dan Obstetri (FIGO) dikombinasikan dengan klasifikasi A merican Joint Committee of Cancer (AJCC).…”