Primary malignant melanoma of the vagina

Background  

Primary vaginal melanoma is a rare, highly malignant, and poor prognostic disease.     

Radiopharmaceutical-guided surgery in primary malignant melanoma of the vagina.

The sentinel lymph node located in the right iliac basin was successfully pre- and intraoperatively identified by radiopharmaceutical-directed mapping in a case of primary malignant melanoma of the vagina.     

Primary malignant melanoma of the vagina: a case report

Primary malignant melanoma of the vagina is a very rare, but very aggressive tumor. We describe a case of primary vaginal melanoma and review the literature. The patient, a 73-year-old, gravida 2, para 2 postmenopausal Greek woman, presented with abnormal vaginal bleeding for 30 days. On vaginal examination there was a 5.5 x 5 x 2 cm raised, ulcerated and irregular lesion on the posterior vaginal wall. Pathology examination of the entire specimen demonstrated a nodular vaginal melanoma. The histologic diagnosis was confirmed by positive immunostaining. The patient began postoperative immunotherapy with interferon-a2b. She died 25 months later because of cerebral metastases. In conclusion, the prognosis of vaginal melanoma is very poor, despite the treatment modality, because most cases are diagnosed at a late stage.     

Primary malignant melanoma of the vagina: case report and review of literature

Primary vaginal malignant melanoma is rare, with < 250 reported cases to date. It accounts for < 1% of all melanomas in women, < 10% of all female genital tract melanomas, and < 3% of all vaginal malignancies. Its clinical behavior is notoriously more aggressive than that of cutaneous and vulvar melanoma, with a 5-year survival rate ranging from 5% to 25%. Tumor size is the strongest predictor of survival, whereas tumor thickness is a weak predictor of survival. A case of F.I.G.O. stage I vaginal melanoma encircling and embracing the entire circumference of the middle third of the vagina is described. Tumor size and thickness were 6 cm and 9 mm, respectively. The patient was treated by wide local excision and pelvic radiotherapy, and to date, 11 months after surgery, she is alive and with no evidence of disease. It is concluded that wide local excision followed by pelvic radiotherapy is an appropriate treatment for melanoma confined to the vagina.     

Primary malignant melanoma of the vagina: a report of seven cases

Seven patients with primary melanoma of the vagina, five untreated and two recurrent, are reported. The ages ranged from 25-55 years, with an average of 42.3 years. The common symptoms were vaginal bleeding and a vaginal mass, and the most common site was the posterior wall of the vagina (three of seven patients). Two patients survived for more than five years.     

Primary malignant melanoma of the vagina: a clinicopathological analysis of 10 cases

We retrospectively analyzed clinicopathological findings in 10 cases of primary malignant melanoma of the vagina. The main presenting symptoms were vaginal bleeding, vaginal discharge, and feeling of a mass. The tumors were predominantly located in the lowest one-third and in the anterolateral aspect of the vagina. Patients underwent various surgical procedures, radiation therapy, and chemotherapeutic modalities. The mean survival time and the recurrence time from the time of diagnosis were 15 and 8 months, respectively. The tumors were examined for histological characteristics of cell type, presence of melanin pigment, depth of invasion, vascular invasion, intraepithelial spread, junctional activity, and mitotic count. Of all these histological variables, the mean survival time had a significant correlation to mitotic count (P less than 0.04). We concluded that patients with lower mitotic counts (less than 6 per 10 HPF) had better survival (21 months) compared to patients with mitotic counts greater than 6 per 10 HPF who had a mean survival of only 7 months.     

Primary malignant melanoma of the vagina: Case presentation with special references to electron microscopic findings

A case of primary malignant melanoma which presumably developed from pre-existing pigmented nevi (so-called lentigo maligna) in the vagina is presented. The electron microscopic findings of the tumor itself and of the pigmented nevi surrounding the tumor were of particular significance. Atypical melanocytes were seen in the areas of pigmented nevi, showing a number of dendrites, intracytoplasmic melanosomes and premelanosomes. The premelanosomes exhibited various stages of maturation and those in advanced stages had a definite inner structure with striae made of laterally associated and cross-linked fibrils. The Golgi apparatus was generally prominent and often occupied several sites within a single cell. Lipid droplets, vacuolation and nuclear inclusion bodies were also encountered. On the other hand, the melanoma cells were built up mainly with melanophages containing autophagosomes which were formed with aggregated melanosomes enveloped in a layer of limiting membrane. The cells filled with autophagosomes contained relatively few organelles. Premelanosomes were much rarer than in the pigmented nevi. The cytoplasm occasionally showed clusters of minute granules thought to be glycogen, as well as myelinoid corpuscles and a centriol. The primary occurrence of maligant melanoma in the vagina is discussed with specific reference to histopathological ultrastructure.     

Primary malignant melanoma of the vagina: report of four cases and review of the literature

Four cases of malignant melanoma arising in the vagina are described, and the literature related to this unusual tumor is reviewed. The 2-year survival rate is better following radical surgery than after other treatment modalities; however, the 5-year survival rate is unrelated to type of therapy. Radical surgery appears to control local disease, but fails to address systemic spread of the tumor. Therefore, improvement in survival will require effective systemic therapy.     

Cytological diagnosis of a primary malignant melanoma of the vagina.

The cytological appearances of a primary malignant melanoma of the vagina are described. A diagnosis of melanocarcinoma, made from smears showing malignant cells with melanin pigment in their cytoplasm, was confirmed histologically.     

Primary malignant melanoma of the vagina: a case report and review of the current treatment options

A case with primary malignant melanoma located in the posterior lower third of the vagina was encountered and treated by surgery, postoperative immunotherapy and chemotherapy. The tumor was close to the anal sphincter and posterior exenteration was done to achieve tumor-free surgical margins. The need for such radical treatment prompted us to review the literature and discuss our case with the rarest localization of the tumor in the vagina. We focused on the treatment options and the possible complication that may arise during the treatment of the primary malignant melanoma of the vagina. The need for radical surgery was discussed and the current treatment options were reviewed.     

Primary melanoma of the vagina: a clinicopathologic analysis

Primary melanoma of the vagina is a rare tumor associated with a poor prognosis. The clinical and pathologic features of 15 patients treated at the University of Michigan Medical Center and Bowman Gray School of Medicine are reviewed. The presenting symptom of bleeding was noted in 80% of the patients. The cumulative 5-year survival was 17.4%. Two patients survived more than 5 years. All melanoma tumors were of the nodular type, 66% were located in the lower one-third of the vagina, and all patients were found to have invasion greater than 3 mm at the time of diagnosis. The majority of recurrences were located in the pelvis, with the lung being the most common metastatic site. Data from the literature were incorporated with these patients' data in a meta-analysis. Tumor thickness (6 mm or less) significantly (P = .015) affected the disease-free interval. Tumor size (less than 3 cm) significantly (P = .024) influenced survival, whereas age, stage, tumor location, and tumor thickness did not. There was no significant difference in survival among patients treated by surgical resection, irradiation, or surgical resection plus irradiation. The type of surgery, whether radical or conservative, also did not influence survival. One patient had a complete response to high-dose irradiation fractions (greater than 400 cGy), and this form of irradiation in conjunction with surgical resection is presented as a treatment option.