Vulvar and Vaginal Melanomas—The Darker Shades of Gynecological Cancers

Abstract

Melanomas of the skin are poorly circumscribed lesions, very frequently asymptomatic but unfortunately with a continuous growing incidence. In this landscape, one can distinguish melanomas originating in the mucous membranes and located in areas not exposed to the sun, namely the vulvo-vaginal melanomas. By contrast with cutaneous melanomas, the incidence of these types of melanomas is constant, being diagnosed in females in their late sixties. While hairy skin and glabrous skin melanomas of the vulva account for 5% of all cancers located in the vulva, melanomas of the vagina and urethra are particularly rare conditions. The location in areas less accessible to periodic inspection determines their diagnosis in advanced stages, often metastatic. Moreover, despite the large number of drugs newly approved in recent decades for the treatment of cutaneous melanoma, especially in the category of biological drugs, the mortality of vulvo-vaginal melanomas has remained almost constant. This, together with the absence of specific treatment guidelines due to the lack of a sufficient number of cases to conduct randomized clinical trials, makes melanomas with this localization a discouraging diagnosis, associated with a very poor prognosis. Our aim is therefore to draw attention to this oftentimes overlooked entity in order to encourage the community to employ various strategies meant to increase research in this area. By highlighting the main risk factors of vulvar and vaginal melanomas, as well as the clinical manifestations and molecular changes underlying these neoplasms, ideally novel therapeutic schemes will, in time, be brought into effect.

Vaginal Malignant Melanoma: Case Report and Review of the Literature

“…In general, the female gender appears to be a risk factor for MM, as they are twice as common in women compared to men. In contrast, cutaneous melanoma (CM) distribution is similar between both genders [ 4 ] . Additionally, certain genetic alterations are found to be associated with MM: activating mutations in SF3B1 and KIT, loss of CDKN2A, PTEN or SPRED1, and amplification of CDK4, TERT, KIT, MDM2 or CCND1.…”

“…Gene sequencing of MM helps identify driver mutations and provides therapeutic opportunities for targeted therapy. The most common presenting complaint of vaginal melanomas is genital bleeding, while others include a palpable mass, itching, dyspareunia, yellow genital secretions, and local pain [ 4 ] . The diagnosis of vaginal melanomas includes pathological analysis and IHC of the biopsy sample, imaging to determine extent, and genetic testing.…”

“…IHC can be helpful in difficult cases to confirm that the neoplasm is of melanocytic origin. Widely used markers include protein S-100, melanoma antigen recognized by T-cells-1 (MART-1) or Melan-A, melanoma-specific antigen (HMB-45), microphthalmia transcription factor (MITF), and vimentin [ 4 ] . Due to the lack of an adequate number of cases to conduct randomized clinical trials, prognostic factors and treatment protocols are not clearly defined for vaginal melanoma.…”

Treatment specialty‐specific characteristics and outcomes in women with vulvo‐vaginal melanoma: A JGOG‐JSCS joint study

“…Treatment specialty-specific characteristics and outcomes in women with vulvo-vaginal melanoma: A JGOG-JSCS joint study Melanoma of the female genitalia, including the vulva and vagina, represents a rare type of malignancy that is associated with poor survival outcomes. [1][2][3] Due to the rarity, vulvo-vaginal melanomas have been relatively understudied and treatment often includes overlap between the dermatologists, representing expertise in melanoma, and the gynecologists who possess the expertise in female genital tract malignancy.…”

“…While various studies have reported prognostic factors for vulvovaginal melanomas, [1][2][3][4][5] the prognostic effect of treating specialty for vulvo-vaginal melanomas (dermatologists vs. gynecologists) has not been previously examined. The objective of the current study was to compare characteristics and outcomes of women with vulvo-vaginal melanoma based on the specialty of the physician guiding treatment.…”