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Cuccia F, D'Alessandro S, Blasi L, Chiantera V, Ferrera G. The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy. J Pers Med 2023; 13:1142. [PMID: 37511755 PMCID: PMC10381892 DOI: 10.3390/jpm13071142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Among the mucosal melanomas, vaginal melanomas are very rare tumors, accounting for less than 20% of melanomas arising from the female genital tract. They occur most frequently in women in post-menopausal age, but younger patients may also experience this neoplasm, mainly located in the lower third of the vagina or the anterior wall. The optimal management of this tumor remains controversial, with surgery reported as the most frequently adopted approach. However, a clear benefit of surgical treatment in terms of survival has not yet been demonstrated. Conversely, radiotherapy may represent an attractive non-invasive alternative, and there are several favorable reports of the role of radiation therapy, either delivered with photons, brachytherapy, or hadrontherapy. A wide range of techniques and fractionation regimens are reported with substantially good tolerance to the treatment, and acute G3 or higher toxicities are reported only in the case of concurrent immunotherapy. Of note, due to the rarity of the disease, there is a lack of high-level evidence for the optimal therapeutic option. In this scenario, recent studies theorize the possibility of developing combinatorial approaches of radiotherapy with immunotherapy based on cutaneous melanomas reports. In this review, we aim to summarize the evidence available in the literature supporting the role of definitive radiotherapy for vaginal melanomas, with a focus on the combination of RT with immunotherapy, in terms of optimal timing and biological rationale.
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Affiliation(s)
- Francesco Cuccia
- Radiotherapy Unit, Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
| | - Salvatore D'Alessandro
- Radiotherapy Unit, Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
- Radiation Oncology School, University of Palermo, 90100 Palermo, Italy
| | - Livio Blasi
- Medical Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
| | - Vito Chiantera
- Gynecological Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
| | - Giuseppe Ferrera
- Radiotherapy Unit, Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
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2
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Tarhini AA, Hanayneh WB, Powers JJ, Segura CMM, Conejo-Garcia JR, Lam CA, Hakam A, Hoffman MS. Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma. Front Oncol 2022; 12:1044587. [DOI: 10.3389/fonc.2022.1044587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Optimal management of locally advanced vaginal mucosal melanoma is poorly understood because of its rarity and unique biology. Patients have a poor prognosis despite aggressive management approaches including pelvic exenteration and adjuvant radiation that carry major morbidities. We report a case of a patient in early 40’s who experienced complete pathologic response and organ preservation following immunotherapy consisting of 3 cycles of ipilimumab and nivolumab. Treatment was complicated by a high-grade immune mediated hepatitis that eventually resolved with immunosuppressive therapy. Immune monitoring studies utilizing vaginal tumor biopsies showed evidence of enhanced infiltration by CD3+/CD8+ cytotoxic T-cells and increased expression of MHC-I/PD-L1 within the tumor microenvironment following immunotherapy. The patient continues to be without evidence of disease recurrence by radiologic and gynecologic examinations with more than 2 years of follow up from the time of immunotherapy initiation. To our knowledge, this is the only case report in the literature of a patient with locally advanced vaginal mucosal melanoma experiencing a durable complete pathologic response and organ preservation following immune checkpoint blockade as the only treatment approach.
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DePalo DK, Elleson KM, Carr MJ, Spiess PE, Zager JS. Genitourinary melanoma: An overview for the clinician. Asian J Urol 2022; 9:407-422. [PMID: 36381597 PMCID: PMC9643129 DOI: 10.1016/j.ajur.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/10/2021] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
Abstract
Genitourinary (GU) melanoma is a rare presentation of melanoma accounting for approximately 0.5% of all melanomas. GU melanomas include primary melanomas of the vulva, vagina, uterine cervix, ovary, penis, scrotum, urethra, bladder, ureter, and kidney. These melanomas are often diagnosed in advanced stages and stigma is thought to contribute to delays in presentation. As the likely diagnosing provider, it is imperative that dermatologists, urologists, and gynecologists are aware of these uncommon sites of presentation. While there have been major advances in the treatment of melanomas as a whole in the last 10 years, their applications to GU melanomas have often been overlooked. GU melanomas have not been included in many of the major phase III clinical trials which brought contemporary advanced treatments to market and the prognoses for GU melanomas remain poor. Due to the rarity of GU melanomas, much of the literature provides generalized recommendations across multiple different organs affected by GU melanomas or omits certain topics, making it difficult to appreciate the fundamentals of the individual presentations. This review aimed to provide background information on the pathogenesis and epidemiology of the different sites of GU melanomas and categorize data specific to the presentation, staging, treatment, and prognosis of each type of GU melanoma to guide the clinician. It was also meant to encourage a multidisciplinary approach to the management of these patients as it spans the expertise of surgical oncologists, medical oncologists, radiation oncologist, dermatologists, urologists, and gynecologists.
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Affiliation(s)
| | - Kelly M. Elleson
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael J. Carr
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
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4
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Schonewolf CA, Jaworski EM, Allen SG, McLean K, Lao CD, Schuchter LM, Tanyi J, Taunk NK. Complete Response After Stereotactic Body Radiation Therapy With Concurrent Immunotherapy for Vaginal Melanoma. Adv Radiat Oncol 2021; 7:100839. [PMID: 34934869 PMCID: PMC8654617 DOI: 10.1016/j.adro.2021.100839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/25/2021] [Accepted: 09/28/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
| | | | - Steven G Allen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Karen McLean
- Department of Gynecologic Oncology, University of Michigan, Ann Arbor, Michigan
| | - Christopher D Lao
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lynn M Schuchter
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janos Tanyi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil K Taunk
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Dupré P, Legoupil D, Vigouroux C, Conan‐Charlet V, Kergastel I, Merviel P, Kerfant N. Laparoscopy-assisted immediate vaginal reconstruction with a vertical pedicled deep inferior epigastric perforator flap for primary melanoma of the vagina. Clin Case Rep 2021; 9:e04183. [PMID: 34194773 PMCID: PMC8223693 DOI: 10.1002/ccr3.4183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/08/2021] [Accepted: 04/02/2021] [Indexed: 11/26/2022] Open
Abstract
The vagina is a rare site for primary melanoma. Here, we report on a case of laparoscopy-assisted immediate vaginal reconstruction with vertical pedicled deep inferior epigastric perforator flap.
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Affiliation(s)
- Pierre‐François Dupré
- Gynecology and Obstetrics DepartmentBrest University HospitalBrestFrance
- INSERM UMR 1078Faculté de MédecineUniversité de Bretagne OccidentaleBrest Cedex 2France
| | | | - Camille Vigouroux
- Gynecology and Obstetrics DepartmentBrest University HospitalBrestFrance
| | | | - Isabelle Kergastel
- Radiology and Medical Imaging DepartmentBrest University HospitalBrestFrance
| | - Philippe Merviel
- Gynecology and Obstetrics DepartmentBrest University HospitalBrestFrance
| | - Nathalie Kerfant
- Plastic and Reconstructive Surgery DepartmentBrest University HospitalBrestFrance
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6
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Zabroug S, Lalya I, Nimubona D, Bouzid N, El Omrani A, Khouchani M. Primary Mucosal Melanoma of the Vagina: About a Case Treated by External Beam Radiotherapy and High-Dose-Rate Brachytherapy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Radical surgery is considered not to improve the prognosis of primary malignant melanoma of the vagina (PMMV). This study was carried out to review the general consensus. A systematic review was performed on the basis of data from 10 patients in our cohort and 147 patients in the previous literature. The radicality of the initial surgery (RAINS) score was defined as the total number of points in terms of the resected organs. The target organs were the vagina, vulva, urethra, bladder, uterus, anus, rectum, pelvic lymph nodes, and inguinal lymph nodes. Overall survival (OS) according to the RAINS score was analyzed using the Kaplan-Meier method. Information on tumor stage, size, and depth of invasion was not obtained in 15, 47, and 43% of patients, respectively. The median follow-up period was 18 months. OS with a RAINS score of at least 7 was significantly longer than that with a RAINS score of up to 6 (median survival time, 41 vs. 19 months; log-rank test, P=0.037), despite the fact that the former group included significantly more patients with advanced-stage disease. A significant difference in OS was not found between patients with a RAINS score of at least 6 and up to 5. The therapeutic significance of radical surgery for PMMV has not been assessed appropriately in previous studies because of the lack of comparability among groups and differences in the definitions of surgical radicality. Patients with PMMV might benefit from initial surgery with appropriate surgical radicality, despite incomplete validation of the RAINS score.
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Fort M, Guet S, Husheng S, Calitchi E, Belkacemi Y. Role of radiation therapy in melanomas: Systematic review and best practice in 2016. Crit Rev Oncol Hematol 2016; 99:362-75. [PMID: 26829895 DOI: 10.1016/j.critrevonc.2016.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/02/2015] [Accepted: 01/16/2016] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy has been used for skin cancers since early after the discovery of X-rays. The introduction of sophisticated surgery techniques and information of the general population on potential late radiation-induced toxicity and carcinogenesis have led to limiting indications in the dermatologist community. However, radiotherapy (RT) has undergone considerable developments, essentially including technological advances, to sculpt radiation delivery, with demonstration of the benefit either alone or after adding concomitant cytotoxic agents or targeted therapies. Although side effects due to high doses and/or the use of old RT techniques have been significantly decreased, the risk of atrophic scars, ulcerations or secondary cancers persist. In this systematic review, we aim to discuss indications for RT in melanomas with focus on new advances that may lead to rehabilitating this treatment option according to the tumor radiosensitivity and clinical benefit/risk ratio. Melanomas have been considered as radioresistant tumors for many years.
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Affiliation(s)
- Magali Fort
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Saada Guet
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Shan Husheng
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Elie Calitchi
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France; Henri Mondor Breast Center and University of Paris-Est Creteil (UPEC), Créteil, France
| | - Yazid Belkacemi
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France; Henri Mondor Breast Center and University of Paris-Est Creteil (UPEC), Créteil, France.
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Gynecologic Cancer InterGroup (GCIG) consensus review for vulvovaginal melanomas. Int J Gynecol Cancer 2015; 24:S117-22. [PMID: 24987924 DOI: 10.1097/igc.0000000000000198] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Vulvovaginal melanomas are rare tumors that account for a small fraction of all vulvovaginal cancers. Biologically, they seem to be similar to mucosal and acral melanomas of other sites. There are limited data specific to vulvovaginal melanomas, especially regarding systemic therapies. Most treatment decisions are based on extrapolation from data regarding cutaneous melanomas of other sites. It is reasonable to follow already established guidelines from other professional groups and societies. Outcomes tend to be worse compared with cutaneous melanomas likely because of the later presentation and physical biological characteristics of these tumors.
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Abstract
PURPOSE OF REVIEW Primary melanomas originating from the gynaecological tract are rare and aggressive cancers. The 5-year survival is around 10%. The majority of tumours differ from cutaneous melanomas, which arise from the skin, by developing from melanocytes located in mucosal epithelium. The clinical behaviour, prognosis and the biology of mucosal melanomas are distinct from cutaneous melanomas. In this article, we summarize the current management of melanomas of the gynaecological tract (vulva, vagina, ovary and cervix) and discuss the progress in developing new treatments. RECENT FINDINGS The management of mucosal melanomas has not changed substantially over the last decade and the prognosis remains poor. Surgery remains the primary treatment of choice in all localized melanomas of the genital tract. Radiotherapy and chemotherapy are options but have limited success for the majority of women. Activation of c-KIT occurs in vulvar melanomas. Clinical trials of targeted agents are underway. SUMMARY As a result of the rarity of gynaecological tract melanomas, challenges associated with their anatomical locations and resistance to conventional radiotherapy and chemotherapy, this group of conditions remain difficult to treat and continue to have a poor prognosis. A greater understanding of the molecular profile of these cancers may provide promising targeted approaches.
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Chen L, Xiong Y, Wang H, Liang L, Shang H, Yan X. Malignant melanoma of the vagina: A case report and review of the literature. Oncol Lett 2014; 8:1585-1588. [PMID: 25202372 PMCID: PMC4156219 DOI: 10.3892/ol.2014.2357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 07/01/2014] [Indexed: 12/22/2022] Open
Abstract
Primary malignant melanoma of the vagina is an extremely rare variant of melanoma that accounts for <3% of all vaginal malignancies. Primary malignant melanoma of the vagina has a worse prognosis as compared with non-genital melanomas or other vaginal malignant neoplasms. A-35-year-old female had a diagnosis of primary malignant melanoma of the vagina. A local excision of the tumor was first performed, followed by a radical excision as a further therapeutic measure. The patient returned after three weeks, presenting with a vesico-vaginal fistula. A conservative operation was subsequently performed in order to improve the quality of life of the patient. Pelvic metastases were identified 6 months after the completion of the last surgical therapy and subsequent follow-up examinations were performed in another hospital. The present case study describes the clinical features and surgical procedures of this patient with primary malignant melanoma of the vagina. In conclusion, melanoma of the vagina is an extremely aggressive cancer and the overall prognosis is poor despite the various treatment options.
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Affiliation(s)
- Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Yin Xiong
- Department of Gynecology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Huan Wang
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Lizhi Liang
- Department of Gynecology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Huiling Shang
- Department of Gynecology, The First People's Hospital of Foshan, Guangzhou, Guangdong 528000, P.R. China
| | - Xiaojian Yan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Chaudhuri S, Das D, Chowdhury S, Gupta AD. Primary malignant melanoma of the vagina: A case report and review of literature. South Asian J Cancer 2014; 2:4. [PMID: 24455530 PMCID: PMC3876629 DOI: 10.4103/2278-330x.105861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 60 year old woman presented in gynecology department with bleeding per vagina and subsequently histotpathologically, it was diagnosed as malignant melanoma of the vagina. She underwent excision biopsy. On metastatic work-up, Positron emission tomography (PET) scan proved that she had distant metastasis and received palliative radiotherapy and chemotherapy, with temozolamide. She is alive after one year.
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Affiliation(s)
- Snehamay Chaudhuri
- Department of Obstetrics and Gynecology, NRS Medical College, Kolkata, West Bengal, India
| | - Diptimay Das
- Department of Radiotherapy, NRS Medical College, Kolkata, West Bengal, India
| | - Soham Chowdhury
- Department of Obstetrics and Gynecology, NRS Medical College, Kolkata, West Bengal, India
| | - Anjan Das Gupta
- Department of Obstetrics and Gynecology, NRS Medical College, Kolkata, West Bengal, India
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A large retrospective multicenter study of vaginal melanomas: implications for new management. Melanoma Res 2014; 23:138-46. [PMID: 23449321 DOI: 10.1097/cmr.0b013e32835e590e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The outcome of patients presenting with vaginal melanoma has been assessed in a large multicentric retrospective study. The databases of 12 French institutions were searched for primary vaginal melanomas managed between 1990 and 2007. Among the 54 patients recorded, 46 were managed with a curative intent and included in the study. The clinical characteristics, treatments, and detection of c-KIT protein expression have been studied. The median age of the patients was 63.5 years (42-88). Twenty-eight patients were classified as International Federation of Gynecology and Obstetrics (FIGO) stage I, five as stage II, six as stage III, and one as stage IVA. c-KIT protein was overexpressed in 80% of the patients. Forty-two patients underwent surgical resection of the tumor, nine patients received local adjuvant treatment, and 10 received systemic adjuvant therapy. The median relapse-free survival was 10.9 months. c-KIT-negative status (P=0.01) and stage I (P=0.02) were associated with locoregional recurrence. The rate of metastasis was increased for advanced FIGO stages (P<0.01). The median overall survival (OS) was 28.4 months. The finding of lymph node metastasis adversely affected OS (P<0.01). Conservative surgery and radiotherapy were associated with a decrease in metastasis-free and OS (P<0.01) compared with surgery alone, this group of patients presenting with advanced FIGO stages (P=0.02). Despite the use of limited data, conservative surgery combined with a sentinel lymph node procedure, followed by adjuvant radiotherapy could be proposed to patients with early FIGO stage in the absence of validated management. c-KIT negativity by immunochemistry appears to be a poor prognosis marker in terms of locoregional recurrences but not for metastatic spread nor survival. Further assessment of the role of c-KIT expression in this disease is thus mandatory to select patients for targeted therapy.
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Xia L, Han D, Yang W, Li J, Chuang L, Wu X. Primary Malignant Melanoma of the Vagina: A Retrospective Clinicopathologic Study of 44 Cases. Int J Gynecol Cancer 2014; 24:149-55. [DOI: 10.1097/igc.0000000000000013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThis study aimed to identify prognostic factors of survival and improve treatment strategies in women diagnosed with primary malignant melanoma of the vagina.MethodsBetween December 2002 and August 2011, 44 patients with lesions confined to the vagina and diagnosed with melanoma at Fudan University Shanghai Cancer Center were evaluated retrospectively. Prognostic factors were analyzed by Kaplan-Meier method.ResultsWith a median follow-up time of 18.9 months (range, 6.0–94.3 months), 30 (68.2%) patients developed recurrences, whereas 21 (47.7%) died of disease. Median progression-free survival (PFS) was 14.4 months and median overall survival (OS) was 39.5 months. Depth of invasion (DOI) was significantly associated with OS (P = 0.023), and there was an obvious tendency toward improved OS with a negative lymph node status (P = 0.063). The DOI was significantly associated with lymph node status (P = 0.047). The extent of surgery (wide local excision vs radical excision) was not associated with differences in PFS or OS (P = 0.573 and P = 0.842, respectively). Longer PFS was observed in patients who received adjuvant chemotherapy and radiotherapy (P = 0.038).ConclusionsThe prognosis of primary vaginal melanoma is dependent on the DOI and lymph node status in our study. Surgical resection of disease, especially wide local excision, should be considered as the optimal treatment when complete removal of tumor with a negative margin is possible. Adjuvant therapy may be associated with a longer PFS.
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Vaginal primary malignant melanoma: a rare and aggressive tumor. Case Rep Obstet Gynecol 2013; 2013:137908. [PMID: 23970985 PMCID: PMC3736526 DOI: 10.1155/2013/137908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022] Open
Abstract
Vaginal primary malignant melanoma is a rare and very aggressive tumor. It most commonly occurs in postmenopausal women, with a mean age of 57 years. Our patient is an 80-year-old, postmenopausal Greek woman presented with a complaint of abnormal vaginal bleeding. On gynecologic examination there was a pigmented, raised, ulcerated, and irregular lesion 5 × 4.5 cm in the upper third of anterior vaginal wall. She underwent a wide local excision of the lesion. The histopathology revealed vaginal primary malignant melanoma with ulceration and no clear surgical margins. She denied any additional surgical interventions and underwent to postoperative adjuvant radiotherapy. Follow up 5 months after initial diagnosis revealed no evidence of local recurrence or distant metastasis. The prognosis of vaginal primary malignant melanoma is very poor despite treatment modality, because most of the cases are diagnosed at advanced stage. Particularly patients with no clear surgical margins and tumor size >3 cm needed postoperative adjuvant radiotherapy.
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Albareda J, Olier C, Alemany I. Primary melanoma of the vagina. A clinical case. J Turk Ger Gynecol Assoc 2011; 12:50-2. [PMID: 24591958 DOI: 10.5152/jtgga.2011.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 06/27/2010] [Indexed: 11/22/2022] Open
Abstract
Primary melanoma of the vagina is a rare neoplasm that appears in the 6(th) and 7(th) decades of life. It has a poor prognosis, for which there is no consensus regarding treatment; indeed, the literature describes a number of therapeutic options. This paper describes a patient with vaginal melanoma treated by local excision and immunotherapy.
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Affiliation(s)
- Judit Albareda
- Department of Obstetrics and Gynaecology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | - Clara Olier
- Department of Medical Oncology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | - Isabel Alemany
- Department of Pathology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
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Gungor T, Altinkaya SO, Ozat M, Bayramoglu H, Mollamahmutoglu L. Primary Malignant Melanoma of the Female Genital Tract. Taiwan J Obstet Gynecol 2009; 48:169-75. [DOI: 10.1016/s1028-4559(09)60281-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Baloglu A, Bezircioglu I, Cetinkaya B, Yavuzcan A. Primary malignant melanoma of the vagina. Arch Gynecol Obstet 2009; 280:819-22. [PMID: 19242707 DOI: 10.1007/s00404-009-1009-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 02/10/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Primary vaginal melanoma is a rare, highly malignant, and poor prognostic disease. CASE The 51-year-old patient with diagnosis of vaginal malignant melanoma was referred to our clinic. Since detection of pervasive brown lesions in the vagina total vaginectomy was performed. At pathological investigation melanoma was not determined. Immunotherapy was administered adjuvantly. Paraaortic lymph node metastasis was seen on the ninth month after total vaginectomy and the metastatic lymph nodes were excised. Cisplatin and tremozolamide chemotherapy was administered for six cycles after surgery. The patient is alive and disease-free at 18th month of the diagnosis of the disease. CONCLUSION The impact of therapy on outcome of primary vaginal malign melanomas is poorly understood. Improved clinical outcomes were associated with surgical removal of gross disease whenever possible. Because of the low rate of lymph node metastasis, elective pelvic lymph node dissection is not mandatory. We presented a case of FIGO stage I primary vaginal malignant melanoma, which metastasized to the paraaortic lymph nodes 9 months after the primary operation.
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Affiliation(s)
- Ali Baloglu
- 1st Department of Obstetrics and Gynecology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
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Abstract
PURPOSE OF REVIEW The significant increase in cutaneous melanomas over the past 30 years has led to studies resulting in advances in their diagnosis, staging, surgical treatment, and adjuvant therapies. Similar approaches have been investigated in patients with far rarer malignant melanomas of the female genital tract. This review will summarize the current state of knowledge on the incidence, causes, presenting symptoms, prognostic factors, therapeutic approaches, and outcomes, site-by-site, for primary melanomas of the vulva, vagina, urethra, ovary, and the uterine cervix. RECENT FINDINGS Surgery remains the initial treatment of choice for localized melanomas of the female genital tract, with less radical, organ function preserving resections demonstrating similar control rates compared with more radical surgical approaches in vulva and possibly vaginal melanomas. Radiation therapy may play a role in the treatment of patients with close resection margins, regional nodal metastasis, or unresectable tumors. Sentinel lymph node studies, positron emission tomography and computed tomography scans for staging and evaluation of response, and adjuvant chemo or biochemotherapy warrant further investigation. SUMMARY The results of treatment for female genital tract melanomas remain poor. Although surgery remains the initial treatment of choice for localized disease, adjuvant local-regional, and systemic therapies are needed.
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McGuire SE, Frank SJ, Eifel PJ. Treatment of recurrent vaginal melanoma with external beam radiation therapy and palladium-103 brachytherapy. Brachytherapy 2008; 7:359-63. [DOI: 10.1016/j.brachy.2008.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 03/29/2008] [Accepted: 04/16/2008] [Indexed: 11/27/2022]
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Ohno T, Kato S, Sasaki E, Mizutani K, Tsujii H. Carbon ion radiotherapy for vaginal malignant melanoma: a case report. Int J Gynecol Cancer 2007; 17:1163-6. [PMID: 17451456 DOI: 10.1111/j.1525-1438.2007.00951.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Malignant melanoma of the vagina is a very rare neoplasm and resistant to conventional radiotherapy. We report a case of vaginal malignant melanoma that was locally well controlled by carbon ion radiotherapy. A 55-year-old postmenopausal woman presented with abnormal vaginal bleeding. On pelvic and imaging examinations, an irregular mass of the posterior vaginal wall sized 7.5 x 5 x 5 cm, an enlarged right inguinal lymph node, and two lung metastases were observed. Histologic diagnosis based on positive immunostaining for HMB-45 was malignant melanoma. She received dacarbazine-based chemotherapy and carbon ion radiotherapy for vaginal and inguinal tumor sites with 57.6 Gy equivalent dose per 16 fractions using five ports. Six months later, she was also given carbon ion radiotherapy for regrowing lung metastasis with 52.8 Gy equivalent dose per four fractions using four ports. She died 19 months after initial treatment due to brain metastases. The primary irradiated tumor disappeared completely 12 months after initial treatment. The vaginal tumor, right inguinal lymph node, and lung tumor treated with carbon ion radiotherapy did not show any evidence of recurrence until her death. Carbon ion radiotherapy may be of value for vaginal malignant melanoma as a conservative approach.
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Affiliation(s)
- T Ohno
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
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24
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Betschart C, von Orelli S, Mihic D, Fink D. [Primary malignant melanoma of the vagina--case report and review of the literature]. ACTA ACUST UNITED AC 2007; 47:39-44. [PMID: 17272935 DOI: 10.1159/000098124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 12/20/2005] [Indexed: 11/19/2022]
Abstract
The primary malignant melanoma of the vagina is a very rare tumor with less than 300 cases reported worldwide. Metastatic melanomas of the vagina are even rarer and only 5 cases have been reported so far. We describe the case of patient with a melanoma of the left side of the vagina with a tumor size of 6 cm and a tumor invasion of 2.5 cm. At the time of diagnosis there were no signs of nodal metastases in the positron emission tomography. In the literature, wide local excision with adjuvant radiotherapy is recommended, and radical surgery with adjuvant radiotherapy as second-line therapy. Both procedures show similar 5-year survival rates. To reduce the risk of metastases, we had planned an immunotherapy with interferon-alpha, which has been shown to improve relapse-free and overall survival in patients with high-risk cutaneous melanoma. Unfortunately, the cancer was found to have heavily metastasized 6 months later; the patient therefore received a palliative chemotherapy with dacarbazine and thalidomide.
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Affiliation(s)
- C Betschart
- Klinik fur Gynakologie, Departement Frauenheilkunde, Zurich, Schweiz.
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25
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Gökaslan H, Sişmanoğlu A, Pekin T, Kaya H, Ceyhan N. Primary malignant melanoma of the vagina: a case report and review of the current treatment options. Eur J Obstet Gynecol Reprod Biol 2005; 121:243-8. [PMID: 16054970 DOI: 10.1016/j.ejogrb.2004.11.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2004] [Revised: 09/09/2004] [Accepted: 11/19/2004] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Hüsnü Gökaslan
- Marmara University Hospital, Marmara School of Medicine, Department of Obstetrics and Gynecology, Altunizade, Istanbul, Turkey
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26
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Huang HK, Liu IF, Chou CY, Cheng YM, Ho CL. Primary Vaginal Amelanotic Melanoma. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Signorelli M, Lissoni AA, Garbi A, Perego P, Mangioni C. Primary malignant vaginal melanoma treated with adriamycin and ifosfamide: A case report and literature review. Gynecol Oncol 2005; 97:700-3. [PMID: 15863186 DOI: 10.1016/j.ygyno.2005.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 02/01/2005] [Accepted: 02/02/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vaginal melanoma is a very rare but highly malignant gynecological disease, usually diagnosed in postmenopausal woman. The prognosis tends to be poor and it is associated with high rate of recurrence and short survival rates. CASE The following paper describes a case report regarding a 72-year-old woman with a locally advanced malignant melanoma. The previous erroneous histopathological diagnosis was leiomyosarcoma. She underwent chemotherapy with 3 courses of doxorubicin and ifosfamide. The diagnosis of malignant melanoma was obtained after a repeated biopsy and further pathological investigations. She later underwent radical surgery and 2 additional cycles of the same chemotherapy. At present, 7 months after the last cycle, the patient was locally disease-free, but developed brain metastases, requiring chemotherapy treatment. CONCLUSION In view of poor survival, this chemotherapy regimen may be an interesting alternative to the traditional treatment of vaginal melanoma.
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Affiliation(s)
- M Signorelli
- Department of Obstetrics and Gynecology, Division of Gynecology/Oncology, University of Milan-Bicocca, Milan, Italy.
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28
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Oudoux A, Rousseau T, Bridji B, Resche I, Rousseau C. Interest of F-18 fluorodeoxyglucose positron emission tomography in the evaluation of vaginal malignant melanoma. Gynecol Oncol 2004; 95:765-8. [PMID: 15582002 DOI: 10.1016/j.ygyno.2004.08.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Indexed: 11/24/2022]
Abstract
BACKGROUND This is the first report of FDG-PET findings in a case of vaginal melanoma. CASE The tumor arose from the anterior wall of the vaginal canal. As the tumor was limited to the vaginal wall and as there was no evidence of distant metastases, the disease was staged as IIC (AJCC 2002). PET-CT images showed two mediastinal foci localized to the left highest mediastinal and subcarinal nodes on fusion PET/CT images. As it was metastatic, the disease was staged IV (AJCC 2002). CONCLUSION In comparison to conventional imaging, FDG-PET provides a more accurate assessment of the extent of disease spread in patients with vaginal melanoma as with cutaneous melanoma. Significant alterations in the surgical management and treatment were made based on PET results.
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Affiliation(s)
- A Oudoux
- Nuclear Medicine Unit, René Gauducheau Cancer Center, Boulevard Jacques Monod, 44805 Saint-Herblain-Nantes, France.
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29
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Moodley M, Daya M, Moodley J. Vaginal malignant melanoma: a case report and literature review. Int J Gynecol Cancer 2004; 14:687-9. [PMID: 15304168 DOI: 10.1111/j.1048-891x.2004.14430.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Vaginal melanomas are rare genital malignancies occurring mainly in the 6th and 7th decades of life. In general, they have a worse prognosis than cutaneous melanomas. In the past, various treatment modalities have been recommended including radical pelvic surgery. However, the prognosis is poor in spite of such radical approaches. More recently, more conservative treatment in the form of wide local excision combined with adjuvant chemotherapy, high-dose radiotherapy, and immunotherapy seem to have promising results. We describe a patient with vaginal malignant melanoma treated with conservative local excision as well as adjuvant radiotherapy, chemotherapy, and interferon.
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Affiliation(s)
- M Moodley
- Gynecology-Oncology Unit, NR Mandela School of Medicine, Durban, South Africa.
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Miner TJ, Delgado R, Zeisler J, Busam K, Alektiar K, Barakat R, Poynor E. Primary vaginal melanoma: A critical analysis of therapy. Ann Surg Oncol 2004; 11:34-9. [PMID: 14699031 DOI: 10.1007/bf02524343] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary vaginal melanoma is a rare and highly malignant disease. The impact of therapy on outcomes is poorly understood. METHODS Records of all patients treated for primary vaginal melanoma at Memorial Sloan-Kettering Cancer Center from 1977 to 2001 were reviewed. Survival analysis was performed based on appropriate patient, tumor, and treatment variables. Pathologic materials were reviewed to confirm the original diagnosis and examine appropriate clinicopathologic features. RESULTS Thirty-five women were treated for vaginal melanoma; the primary treatment selected was surgical for 69% (24) and radiotherapy for 31% (11) of the patients. Surgical removal of the tumor was achieved in 92% (22) of the 24 patients selected for surgical therapy. At operation, radical excision with en bloc removal of involved pelvic organs was performed in 50% (12) of the 24 patients, a wide excision was performed in 42% (10), and a total vaginectomy was performed in 8% (2). Elective pelvic lymph node dissection was performed in 74% (26) of the 35 cases. Lymph node metastasis was found in only 8% (2) of these 26 patients. The overall median survival was 20 months. Primary surgical therapy was associated with longer overall survival (25 vs. 13 months; P =.039). Recurrence-free survival was not associated with the extent of surgery. None of the examined clinicopathologic features were associated with survival differences. CONCLUSIONS The prognosis is poor for patients with primary vaginal melanoma. Improved clinical outcomes were associated with surgical removal of gross disease whenever possible. Because of the low rate of lymph node metastasis, elective pelvic lymph node dissection is not obligatory. In cases of surgically unresectable disease, primary radiation therapy is indicated.
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Affiliation(s)
- Thomas J Miner
- Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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32
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Nakagawa S, Koga K, Kugu K, Tsutsumi O, Taketani Y. The evaluation of the sentinel node successfully conducted in a case of malignant melanoma of the vagina. Gynecol Oncol 2002; 86:387-9. [PMID: 12217768 DOI: 10.1006/gyno.2002.6763] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The sentinel node biopsy has been established as a standard procedure in many types of cancer. To date, only one case was reported for successful detection of the sentinel node using a radiopharmaceutical-directed mapping technique in malignant melanoma of the vagina. CASE An 81-year-old woman developed malignant melanoma arising from the lower third of the vagina. She underwent local resection of the tumor and exploration of the sentinel node using blue dye. The sentinel node was detected successfully in the groin, and was negative for metastasis. Intra-cavity irradiation was given as an adjuvant therapy. CONCLUSION In view of relative ease and minimal trauma, sentinel node mapping could be a routine procedure in malignant melanoma arising from the vagina or vulva.
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Affiliation(s)
- Shunsuke Nakagawa
- Department of Obstetrics and Gynecology, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-8655, Japan.
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Prada M, Fernández Martínez R, Argüells M, Núũez R, García Huelmo J, Solís J. Melanoma de vagina en una mujer de 94 años de edad. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2002. [DOI: 10.1016/s0210-573x(02)77183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rodier JF, Janser JC, David E, Routiot T, Ott G. Radiopharmaceutical-guided surgery in primary malignant melanoma of the vagina. Gynecol Oncol 1999; 75:308-9. [PMID: 10525394 DOI: 10.1006/gyno.1999.5577] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- J F Rodier
- Department of Surgical Oncology, Nuclear Medicine Division, Paul Strauss Comprehensive Cancer Center, 3, Rue de la Porte de l'Hôpital, Strasbourg Cedex, F. 67085, France.
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Brooks SE, Wakeley KE. Current trends in the management of carcinoma of the cervix, vulva, and vagina. Curr Opin Oncol 1999; 11:383-7. [PMID: 10505776 DOI: 10.1097/00001622-199909000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this review, current basic and clinical literature that describes innovative strategies for staging diagnosis and management of cancers of the cervix, vulva, and vagina are reviewed. The reviewed literature includes investigations of viral oncogenesis, the role of angiogenesis in tumor development, pretreatment staging, and the emerging role of chemotherapy in the treatment of locally advanced disease.
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Affiliation(s)
- S E Brooks
- Obstetrics and Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore 21201, USA.
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