Primary malignant melanoma of the cervix: a rare disease

Abstract

Malignant melanoma (MM) arising primarily in the cervix is exceedingly rare and has a poor prognosis. We report the case of a primary MM of the cervix in a 64-year-old woman with vaginal bleeding. She presented with a cervical amelanotic lesion which on biopsy rendered the diagnosis of MM. The patient was staged as International Federation of Gynecology and Obstetrics IIB and underwent Wertheim-Meigshysterectomy followed by brachytherapy. One year later, she was diagnosed with a large pelvic relapse for which surgery was performed. She then presented with a vaginal relapse and an isolated hepatic lesion, both of which were proposed for surgery. The diagnosis of MM of the cervix is a clinical and pathological challenge due to its rarity and overlapping features. Cytology cannot accurately diagnose it. Moreover, amelanotic MMs must be distinguished from other poorly differentiated carcinomas by diagnosis that ultimately relies on immunohistochemical staining. Radical surgery is the only treatment showing predictive benefit.

Cytology of an ulceroproliferative cervical mass

“…Mucosal melanoma constitutes less than 2% of all melanomas, the majority of which are located in the head‐neck region, anorectal region and vulvovaginal region . Cervical melanoma is an extremely uncommon entity (almost 80 cases reported) although its occurrence is well known in clinical practice . In contrast to its cutaneous counterpart, mucosal melanoma occurs more commonly in elderly women .…”

“…It can present as an amelanotic/melanotic nodule/polyp or an ulceroproliferative mass. The patient presents with the complaint of bleeding per vagina/mass per vagina/anaemia …”

“…The cervical cytology shows characteristic features although it cannot distinguish between primary and metastatic melanoma. 2,4 The cytopathologist should be aware of this entity for its confident diagnosis in cervical cytology.…”

“…Masson-Fontana and Schmorl's stains can distinguish melanin pigment from many other brown-black pigments and this tumour is positive for S100 (nucleocytoplasmic), HMB45 (cytoplasmic) and Melan-A (cytoplasmic) immunohisto-chemistry. It can be also positive for CD117 (c-kit) and BRAF based on its molecular pathogenesis 2,3.…”

Primary malignant melanoma of the female urethra − a case report

“…Malignant melanoma (MM) accounts for 3% of all cancers in Europe [1]. The incidence of MM in white females is 14.7 -15.2 per 100.000, while it is less common in Asian and Black females [2]. However, MM of the genitourinary tract is very rare, accounting for 1% of all cases [3,4].…”