Malignant nodular melanoma of the vulva: a rare and aggressive tumour of the female genital tract (case report)

Abstract

Malignant melanoma of the vulva is a rare and aggressive tumour with dismal prognosis. It tends to recur and metastasize early. Surgical excision with or without regional lymph node dissection is still the treatment of choice with adjuvant therapy decided on a case by case. Furthermore, HIV infection has been associated with more aggressive disease. Herein we present a 45-year-old HIV-infected female patient on antiretroviral therapy who presented with vulval ulcer for one year. On examination, she had ulcerated nodule on the labia majora. Radiology showed vulvovaginal tumour without involvement of the adjacent organs. Malignant melanoma was confirmed on both the incisional biopsy and vulvectomy. She responded poorly to radiotherapy. Furthermore, she presented with recurrence and metastatic disease a month after surgery. She was lost to follow-up clinic.

Vulvar malignant melanoma: a case report and review of management

“…2 Epithelioid type is the most common histological cell types, followed by spindle and mixed type. 5 Immunohistochemical staining showed positive for S-100, HMB-45, and Melan-A, which are all evidence in this case. The S-100 presents the highest sensitivity (97-100%), while the Melan-A protein demonstrates the highest specificity (95-100%).…”

“…2,3 Patient may present late or during advanced disease due to the absence of early signs, low body awareness to this location, and being misdiagnosed with benign disease. 3,5 Approximately one-third of patients may present with lymph node involvement. 5 The predisposing factors for VMM includes ulcerated lesion, previous local radiation, human papillomavirus infection, diabetes mellitus, or immunocompromised.…”

“…3,5 Approximately one-third of patients may present with lymph node involvement. 5 The predisposing factors for VMM includes ulcerated lesion, previous local radiation, human papillomavirus infection, diabetes mellitus, or immunocompromised. 2 In the case of our patient, her likely risk factors were advanced age, postmenopausal status, and diabetes status.…”

“…It can cause metastasis to regional lymph nodes, lungs, bones, peritoneum, liver, and brain, with the lung being the most common site, followed by the liver and brain. 2,5 Local tumour extension and soft tissue assessment are ideally done by pelvic MRI. Once vulva melanoma has been diagnosed, a total-body, skin, and eye examination is required to rule out other primary disease sites.…”

“…[1][2][3][4] Despite its rarity, it is the second most common type of malignancy of the vulva after squamous cell carcinoma (incidence of 10%). 1,5 Given such rarity, the standard treatment is less clearly defined and is mainly extrapolated from the management of cutaneous melanomas. 1,3 Herewith is a report on a case of malignant vulvar melanoma and a discussion of the management approach.…”