Primary vaginal melanoma: A critical analysis of therapy

Abstract

The prognosis is poor for patients with primary vaginal melanoma. Improved clinical outcomes were associated with surgical removal of gross disease whenever possible. Because of the low rate of lymph node metastasis, elective pelvic lymph node dissection is not obligatory. In cases of surgically unresectable disease, primary radiation therapy is indicated.

Primary Malignant Vaginal Melanoma - Case Report and Review of the Literature

“…In the study by Miner et al (n = 35), typical prognosis-relevant factors such as age, depth of invasion, pigmentation, ulceration and even adjuvant therapy were not found to be correlated with patient outcome. Even the microscopic assessment of positive and negative resection margins did not show any significant difference in recurrence-free survival times [7]. Meta-analyses by Reid et al and Buchanan et al also showed no correlation between the depth of tumour invasion and patient survival [2,12].…”

“…Thus, 3 of 7 patients with a tumour < 3 cm survived more than 5 years while none of the patients with a tumour > 3 cm survived longer than 5 years [10]. The median survival rate after diagnosis is approximately 20 months [7]. Primary surgery is considered the method of choice and appears to be superior to primary radiation (25 vs. 13 months; p = 0.039).…”

“…Only Van Nordstrand et al reported in their study that radical surgery (total colpectomy or evisceration) offered a superior outcome compared to "wide local excision" or radiation with regard to the 2-year survival rate [15]. Other authors did not find any significant differences in survival rates with different surgical procedures [7,12]. Due to the poor prognosis of vaginal melanoma, the aim must be to obtain local excision with a tumour-free resection margin.…”

“…imatinib, sunitinib) when c-kit mutations were present [13]. Radiotherapy is usually used to treat primary non-resectable tumours and when resection margins are positive [6,7]. Therapy consists of intracavitary brachytherapy with 2-5 applications of caesium-137 (0.7-20 Gy per dose) [11].…”

Primary Vaginal Melanoma, A Rare and Aggressive Entity. A Case Report and Review of the Literature

“…The patients who underwent surgery first were found to have a better survival compared to those in whom primary radiotherapy was performed. The thorough removal of the macroscopic tumor and negative free margins were found to be effective in guaranteeing local control and improving survival (26). Radical surgery and lymphadenectomy with adjuvant chemo-or radiotherapy is used as an aggressive treatment for advanced stages of primary malignant vaginal melanoma (2,17,22).…”