Primary Melanoma: from History to Actual Debates

Testori, Alessandro; Blankenstein, Stéphanie A.; Akkooi, A.C.J. van

doi:10.1007/s11912-019-0843-x

Cited by 11 publications

(11 citation statements)

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“…While no studies have compared different surgical approaches in the management of clitoral melanoma, several retrospective studies have addressed the optimal surgical approach for the management of vulvovaginal melanoma. These studies agree that radical vulvectomy is associated with higher morbidity and does not improve overall and disease-free survival compared to less radical approaches [ 1 , 19 , 20 ]. Additionally, several studies have addressed the appropriate surgical margins to achieve for the resection of vulvovaginal melanomas.…”

Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

“…The vast majority of melanomas originate from the skin, owing to sun exposure as the major risk factor [ 1 , 2 ]. Primary mucosal melanomas, which do not occur at sun-exposed sites and whose risk factors are largely unidentified, represent less than 3% of all melanomas [ 1 , 2 ]. Female genital tract melanomas account for approximately 20% of mucosal melanomas, with the majority of these being of vulvovaginal origin.…”

Section: Introductionmentioning

confidence: 99%

“…Female genital tract melanomas account for approximately 20% of mucosal melanomas, with the majority of these being of vulvovaginal origin. The five-year survival rate of vulvar melanoma is estimated to be 40% [ 1 ]. Surgical excision with clear margins, ideally 1–2 cm, remains the primary treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical excision with clear margins, ideally 1–2 cm, remains the primary treatment. There is no supporting evidence that radical vulvectomy (with or without inguinal lymphadenectomy) is associated with improved disease-free survival or overall survival, and it is associated with higher morbidity compared to wide local excision or partial vulvectomy with negative margins [ 1 ]. The function of radiation therapy is limited, and radiation therapy is used almost exclusively in cases of unresectable disease [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Management of Clitoral Melanoma Presenting as an Exophytic Clitoral Mass: A Case Report and Review of the Literature

et al. 2021

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Primary mucosal melanomas of the female genital tract account for one percent or less of all cases of melanoma with even fewer originating in the clitoris. Given the rarity of diagnosis of clitoral melanoma, there is a paucity of data guiding management. There is no supporting evidence that radical vulvectomy (with or without inguinal lymphadenopathy) is associated with improved disease-free or overall survival compared to partial vulvectomy or wide local excision. Additionally, there is no data to evaluate the role of sentinel lymph node biopsy or extensive lymphadenectomy in clitoral melanoma, however previous evidence demonstrates the utility of regional lymph node sampling in predicting survival in women with female genital tract mucosal melanoma. Adjuvant therapy considerations are often extrapolated from their use in treating cutaneous melanomas, including immune checkpoint inhibitors and other immunotherapy agents. Adjuvant radiation therapy has limited utility except in cases of bulky, unresectable disease, or when inguinal lymph nodes are positive for metastasis. The 52 year-old patient presented in this review was diagnosed with locally invasive advanced stage clitoral melanoma presenting as an exophytic clitoral mass. She underwent diagnostic primary tumor resection, which demonstrated ulcerative melanoma with spindle cell features extending to a Breslow depth of at least 28 mm. She subsequently underwent secondary wide local excision with groin sentinel lymph node biopsy, and adjuvant treatment with pembrolizumab. This article also emphasizes the importance of a multidisciplinary team involving gynecologic oncology, medical oncology, radiology, and pathology for management of this rare type of primary mucosal melanoma of the female genital tract.

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Section: Discussionmentioning

confidence: 54%