Melanoma of the Vagina: Case Report and Systematic Review of the Literature

Abstract

Abstract. Background: Primary melanoma of the vagina (PMV) is a rare entity. The prognosis of women with PMV is poor and there is no standardized therapy for this type of malignancy. We present the case of a 72-year-old womanwith PMV (cT2, pN0, M0 Melanoma is caused by the malignant transformation of pigment cells. Apart from the skin, pigment cells such as melanocytes are present in various mucosal linings such as those of the gastrointestinal, respiratory, and urogenital tracts (1). Thus, in addition to the common cutaneous locations, melanomas may also arise in mucosal areas of various organs. Cutaneous melanomas are estimated to be the sixth most common cancer entity among females in the US (2). In contrast, mucosal melanomas are rare and account for only 1.4% of all melanomas. Of note, gender plays an important role in the epidemiology of mucosal melanomas. With almost three cases per million women, which is half that for men, mucosal melanomas are significantly more often diagnosed among women (3). This gender gap is caused by the fact that genital tract mucosal melanomas are more common among women than they are among men, whereas extra-genital mucosal melanomas are evenly distributed between the sexes (3).In the female genital tract, the predominant location of melanoma is the vulva whereas the vagina is rarely affected (3). Specifically, the incidence of primary melanoma of the vagina (PMV) is about three cases per 10,000,000 women per year. Primary melanomas of the vulva are four to nine times more frequent than PMV (4, 5). PMV is typically diagnosed in elderly women at an advanced stage and is characterized by early recurrence and a poor prognosis (2). The 5-year overall survival rate for PMV is below 20% compared to around 45% for those with vulvar melanoma and >80% for those with cutaneous melanoma (2-6). This remarkable difference has been attributed to a variety of 6911 This Αrticle is freely accessible online.

An extremely rare case of vaginal melanoma treated with hysterocolpectomy

“…Surgery, combined with adjuvant radiotherapy, chemotherapy and immunotherapy (interferon alpha) have been discussed as other modes of treatment [8]. Since the patient is physically weak and at the extreme of age, she was not offered adjuvant radiotherapy.…”

Cancer of the vagina: 2021 update

“… 51 In a 2017 systematic review of 805 cases reported over the last 20 years (mostly case reports), the mean recurrence‐free survival was short, at 16 months, with a mean overall survival of only 22 months. 52 …”

Primary Vaginal Amelanotic Melanoma: A Diagnostic Conundrum

“…Hence, the skin is the most common site of melanoma, with cutaneous melanoma (CM) being the 19th most common cancer worldwide [ 3 ]. The vagina is a rare site for the origin of mucosal melanoma (MM) and accounts for only 0.3%-0.8% and, in some studies, up to 1.4% of all melanomas [ 4 , 5 ]. MMs are considerably more common in women than in men.…”

“…MMs are considerably more common in women than in men. Primary vaginal malignant melanoma (PVMM) usually develops in the lower third and is mostly present as either inconsistently pigmented grey or black nodular, fungating or polypoid soft mass ranging from 0.5 to 0.8 cm in size in the anterior wall of the vagina [ 5 , 6 ]. Most patients with PVMM present with irregular vaginal bleeding or increased discharge from the vagina.…”

“…Most patients with PVMM present with irregular vaginal bleeding or increased discharge from the vagina. Some patients may present with a gradually enlarging vaginal wall mass or dyspareunia [ 5 , 6 ]. PVMM commonly occurs in postmenopausal women, with an average age at diagnosis of 68 years (wide age range of 28-100 years).…”