1021 V-y flap reconstruction for vulvar cancer recurrence after primary radiotherapy

Abstract

patients gynecologic examination revealed pigmented lesion from which a biopsy was taken. Histologic examination indicated the diagnose of a melanoma. The mean tumor's size was 3.5 ± 2.1 cm with clinically negative nodes and a mean Breslow depth 11.2 ± 8.7 mm. PET-CT was solicited as presurgical imaging workup.According to the AJCC Cancer Staging Manual, 3/7 (42.8%) of patients were diagnosed at IIC stage, 1/7 (14.3%) at IIIB stage, 2/7 (28.6%) at IIIC stage and 1/7 (14.3%) at IV stage. The treatment was surgery: 3/7 (42.8%) of patients underwent wide local excision and 4/7 (57.2%) of patients underwent hemivulvectomy. Negative margins were obtained in 4/7 (57.2%) of surgerys. Sentinel lymph node (SLN) biopsy was performed in 5/7 (71.4%) of patients and SLN confirmed nodal metastases in 4/5 (80%) of patients. Immunotherapy was the adjuvant treatment for patients with ! IIIB stage (4/ 7), one of them combined with radiotherapy.During the follow up, 5/7 (71.4%) of patients relapsed. The mean time to relapsed was 5.5± 2.3 months. The treatment for the recurrences was 3/5 (60%) cytoreductive surgery combined with immunotherapy in two patients. One woman (20%) received a combination of radiotherapy and immunotherapy and other woman (20%) received palliative treatment. At the time of last follow up, 4/7 (57.2%) women died because of melanoma, 2/7 (28.6%) was tumor free and 1/7 (14.3%) was alive with the disease. Conclusion* As reported in literature, primary vulvar melanomas have biologically aggressive characteristics. The treatment consists of a surgery with appropriate free surgical margins. However, early recognition is what brings the maximal benefit to survival.