Malignant melanoma of the vulva treated by radical hemivulvectomy. A prospective study of the gynecologic oncology group

Abstract

Background. Beginning in 1983, the Gynecologic Oncology Group (GOG) conducted a prospective clinicopathologic study of primary malignant melanoma of the vulva. The objectives of this study were to determine the relationship of histopathologic parameters and microstaging to the International Federation of Gynaecology and Obstetrics (FIGO) staging and prognosis. Methods. All patients with primary untreated malignant melanoma of the vulva and no history of previous or subsequent other primary invasive malignancy were eligible for study entry. All patients were required to have modified radical hemivulvectomy as minimal therapy. Groin dissection was optional. Histopathologic specimens were reviewed for capillary space involvement, Clark's level, Breslow's depth of invasion, cell type, and melanin distribution. Patient characteristics were analyzed in their relationship to groin node status and recurrence‐free interval. Results. Between 1983 and 1990, 81 patients were entered in the study. Of these, 71 were evaluable. Thirty‐four patients underwent radical hemivulvectomy, and 37 patients underwent radical vulvectomy. In addition, 56 patients underwent groin node dissection. The factors that were independently correlated with groin node status were: capillary lymphatic space involvement (P = 0.0001) and central primary tumor location (i.e., bilateral/clitoral/T3) (P = 0.003). The other factors that were significant—clinical tumor size, vulvar staging (FIGO), GOG performance status, and Breslow's depth of invasion—were not independent predictors of positive nodes. The factor with the highest significant correlation with recurrence‐free interval was the 1992 staging system of the American Joint Committee on Cancer (AJCC) for malignant melanoma of the skin. Using multiple regression, AJCC stage was the only independent prognostic factor. In the absence of AJCC stage, Breslow's depth of invasion was the most prognostic. Conclusions. The biologic behavior of vulvar melanoma is similar to other nongenital cutaneous malignant melanoma.

Prognostic Indicators in Melanoma of the Vulva

“…Furthermore, there is no evidence that vulvar melanoma behaves any differently than does cutaneous malignant melanoma. 21,22 Most surgeons have, like us, abandoned radical vulvectomy as the treatment of choice because it is difficult to accept the high complication rate and resulting deformity (which may cause sexual problems and somatopsychic reactions) associated with radical surgery when there is no clear evidence that it provides any improvement in survival.…”

Vulvar melanoma: report on eleven cases and review of the literature

“…5 The biological behavior of primary vulvar and extragenital cutaneous malignant melanoma appeared to be comparable. 13,16 However, some studies 1,3,20 have shown that the overall prognosis for patients with vulvar melanoma is generally poor, compared with cases of cutaneous melanoma and invasive vulvar carcinoma, with a higher tendency towards regional and distant recurrence.…”

“…5,6 However, over the last few years, there have been some reports suggesting that acceptable survival has been achieved through less radical procedures performed on early disease. [6][7][8][9][10][11][12][13][14] In the literature, it is suggested that the clinical and postoperative staging is the most significant predictor of survival. Depth of invasion and presence of ulceration 13,[15][16][17] are the most important histopathological prognostic factors.…”

Primary Mucosal Melanoma: Uncommonly Described Entity

“…Vulvar melanoma is staged according to AJCC TNM classification for cutaneous melanoma [33]. No staging system has demonstrated prognostic accuracy for vaginal melanoma.…”