Surgical Management and Prognostic Factors of Vulvovaginal Melanoma

Abstract

Genital melanomas are characterized by a poor prognosis. Number of mitoses and lymph node status are the main factors influencing survival. Surgery is the mainstay of treatment. A correct and prompt diagnosis is paramount.

Tumor Thickness and Mitotic Rate Robustly Predict Melanoma-Specific Survival in Patients with Primary Vulvar Melanoma: A Retrospective Review of 100 Cases

“…23). Further confounding the dilemma of staging and prognostication, PVMs have been historically characterized together with other melanomas arising on the female genitalia (notably, vaginal melanomas), further obscuring the prognostic features that might be specific to the vulvar origin (5,(24)(25)(26)(27)(28). Furthermore, most studies characterizing clinical and/or histopathologic parameters were often insufficiently powered to reveal relevant prognostic indicators, owing in large part to the relative rarity of PVM (29).…”

“…Furthermore, most studies characterizing clinical and/or histopathologic parameters were often insufficiently powered to reveal relevant prognostic indicators, owing in large part to the relative rarity of PVM (29). Nevertheless, many different clinical and histopathologic variables have been proffered to correlate with a higher risk of disease recurrence and survival in PVM, including higher age at diagnosis (4,(20)(21)(22)30), African American ethnicity (4,5,27,31), higher number of positive regional lymph nodes (4,22,24,29), central and/or multifocal vulvar involvement (21,22,26,30,32,33), increasing tumor thickness (3,9,20,21,(34)(35)(36)(37), ulceration (8,20,30,34,37), and dermal mitotic rate (8,20,24). Identification of the feature(s) among these that independently inform prognosis would greatly improve risk stratification and enable more personalized clinical management for patients with PVM, in particular, earlier and more aggressive intervention for those patients with highest risk disease.…”

Treatment of Genital Melanoma: Are We Ready for Innovative Therapies?

“…2 Among those, 67 (68%) had VM. 3 In our study, we observed that nodal status is the main prognostic factor driving patients' prognosis, thus suggesting the importance of lymph node dissection in this cluster of patients. 2 Unfortunately, the study from Iacoponi et al 1 did not corroborate our results.…”

Primary vaginal melanoma in the setting of mucosal melanosis - A case report and literature review

“…3/14 vaginal melanomas had an NRAS mutation [7,20]. Median survival in patients who were black was significantly reduced; 16 months versus 39 months [9].…”

“…Prognostic factors are debated (8), however a recent study showed mitotic count and lymph node status were the most important histological prognostic factors for disease free survival [9]. Mucosal melanosis, of which genital and specifically vaginal melanosis is a type, is a benign lesion which can mimic melanoma clinically [10][11][12].…”