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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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2
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Vahidfar N, Farzanefar S, Ahmadzadehfar H, Molloy EN, Eppard E. A Review of Nuclear Medicine Approaches in the Diagnosis and the Treatment of Gynecological Malignancies. Cancers (Basel) 2022; 14:1779. [PMID: 35406552 PMCID: PMC8997132 DOI: 10.3390/cancers14071779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/19/2022] [Accepted: 03/26/2022] [Indexed: 12/15/2022] Open
Abstract
Nuclear medicine is defined as the diagnosis and the treatment of disease using radiolabeled compounds known as radiopharmaceuticals. Single-photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/computer tomography (PET/CT) based radiopharmaceuticals have proven reliable in diagnostic imaging in nuclear medicine and cancer treatment. One of the most critical cancers that also relies on an early diagnosis is gynecological cancer. Given that approximately 25% of all cancers in developing countries are a subset of gynecological cancer, investigating this cancer subtype is of significant clinical worth, particularly in light of its high rate of mortality. With accurate identification of high grade distant abdominal endometrial cancer as well as extra abdominal metastases, 18F-Fluorodeoxyglucose ([18F]FDG) PET/CT imaging is considered a valuable step forward in the investigation of gynecological cancer. Considering these factors, [18F]FDG PET/CT imaging can assist in making management of patient therapy more feasible. In this literature review, we will provide a short overview of the role of nuclear medicine in the diagnosis of obstetric and gynecological cancers.
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Affiliation(s)
- Nasim Vahidfar
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran 1419733133, Iran; (N.V.); (S.F.)
| | - Saeed Farzanefar
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran 1419733133, Iran; (N.V.); (S.F.)
| | | | - Eóin N. Molloy
- University Clinic for Radiology and Nuclear Medicine, Faculty of Medicine, Otto von Guericke University (OvGU), 39120 Magdeburg, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Elisabeth Eppard
- University Clinic for Radiology and Nuclear Medicine, Faculty of Medicine, Otto von Guericke University (OvGU), 39120 Magdeburg, Germany;
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Euscher ED, Malpica A. Gynaecological malignancies and sentinel lymph node mapping: an update. Histopathology 2020; 76:139-150. [PMID: 31846525 DOI: 10.1111/his.14017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Assessment of pelvic, para-aortic or inguinal lymph nodes (LNs) provides not only important prognostic information, but also determines the need for adjuvant treatment. Sentinel lymph node (SLN) biopsy has the potential to provide this prognostic information, while reducing morbidity compared with extended LN dissection. This review discusses the clinical and pathological aspects of SLN biopsy in gynaecological cancer.
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Affiliation(s)
- Elizabeth D Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anais Malpica
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lopez S, Guerrisi R, Brusadelli C, Bogani G, Ditto A, Raspagliesi F. The role of sentinel lymph node mapping in lower genital tract melanoma. ACTA ACUST UNITED AC 2020; 72:384-390. [PMID: 32744452 DOI: 10.23736/s0026-4784.20.04628-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Vulvar and vaginal melanomas are rare cancers of the female genital tract and account for 1% to 3% of all melanomas diagnosed in women. Due to the rarity of the disease, few data are available on the clinical and pathologic features of these cancers. Furthermore, treatment options are generally based on extrapolations of the information available for the more common cutaneous counterparts. Surgery represents the mainstay of treatment for lower genital tract melanoma. Moreover, the role of sentinel lymph node (SLN) assessment is controversial because no prospective data are available. EVIDENCE ACQUISITION Data were collected from Medline, Embase, Web of Sciences and Scopus databases. On July 10, 2020, we used the search comprising the terms "vulvar melanoma," "genital melanoma" and "vulvovaginal melanoma" including only studies in which SLN biopsy was performed. EVIDENCE SYNTHESIS Ten retrospective studies have been found. No randomized trials have been reported. The studies included 132 patients while only 63 (47%) undergone SLN. 99mTC with or without blue dye followed by ultrastaging was highly accurate and is currently the gold standard. Mean detection rate was 98.3%. No clear evidence supported the execution of back lymphadenectomy (after SLN mapping), in fact, extrapolating data from cutaneous melanomas of other sites, completion of lymphadenectomy does not confer a melanoma-specific survival advantage. CONCLUSIONS Although the small amount of available data, sentinel lymph node procedure is feasible and capable of identifying patients who have occult lymph node metastases. However, the potential role of the sentinel lymph node procedure as an alternative method of lymph node staging in patients with vulvar or vaginal melanoma needs further investigation.
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Affiliation(s)
- Salvatore Lopez
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy - .,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy -
| | - Rocco Guerrisi
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Claudia Brusadelli
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Giorgio Bogani
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Antonino Ditto
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
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Skanjeti A, Dhomps A, Paschetta C, Tordo J, Giammarile F. Sentinel Node Mapping in Gynecologic Cancers: A Comprehensive Review. Semin Nucl Med 2019; 49:521-533. [DOI: 10.1053/j.semnuclmed.2019.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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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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Ishida H, Nagai T, Sato S, Honda M, Uotani T, Samejima K, Hanaoka T, Akahori T, Takai Y, Seki H. Concomitant sentinel lymph node biopsy leading to abbreviated systematic lymphadenectomy in a patient with primary malignant melanoma of the vagina. SPRINGERPLUS 2015; 4:102. [PMID: 25763309 PMCID: PMC4349903 DOI: 10.1186/s40064-014-0773-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/22/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Primary malignant melanoma of the vagina is an extremely rare disease affecting 3% of patients with malignant vaginal tumors. It is rare compared to primary malignant melanoma of the skin and its prognosis is unfavorable even in patients with Stage I disease. Here, we report a case of primary malignant melanoma of the vagina and discuss our experience with regard to previously published literature. CASE DESCRIPTION The patient was a 59-year-old female with 2 prior pregnancies and child births. She was examined by a local doctor for swelling of the genitalia, and a 1.8 × 1.0 cm large tumor was detected on the left side of the vaginal wall. A biopsy indicated leiomyosarcoma, and she was referred to our hospital. The tumor was resected, and histopathology of the resected sample confirmed the diagnosis of malignant melanoma based on a positive surgical margin. Additional courses of treatment included left inguinal sentinel lymph node biopsy using an isotope and extended vaginectomy. Although the sentinel node was negative, we performed a modified radical hysterectomy and left vaginectomy during the third operation because the surgical margin was positive. We could not confirm whether the lesion in the extracted sample was malignant, and the final diagnosis was primary malignant melanoma of the vagina T4bN0M0 Stage IIc (UICC 2009). Postoperative adjuvant therapy consisted of 6 cycles of DAV-Feron therapy (dacarbazine, ACNU, vincristine, IFN- β). After 5 months of postoperative adjuvant therapy, a 2 cm single lung metastasis was detected in the lower left lung. We performed a laparoscopic lower left lobectomy and are planning additional chemotherapy. DISCUSSION AND EVALUATION Currently, surgical resection has the highest probability of improving the prognosis of patients when used as initial treatment for Stage I disease. By combining treatment with sentinel lymph node biopsy, we were able to accurately determine the stage of disease and thus avoid systematic lymph node dissection and further surgical treatments. CONCLUSION Malignant melanoma of the vagina is very rare tumor so it is necessary to requires the integration of further cases.
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Affiliation(s)
- Hiroaki Ishida
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Tomonori Nagai
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Syo Sato
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Michiko Honda
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Takahiro Uotani
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Kouki Samejima
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Tatsuya Hanaoka
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Taichi Akahori
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Yasushi Takai
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
| | - Hiroyuki Seki
- Saitama Medical Center Japan, Obstetrics and Gynecology, 1981 Kamoda, Kawagoe City, Saitama 350-8550 Japan
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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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9
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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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10
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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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12
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13
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Radioisotopic Location of the Sentinel Node in Vaginal Mucous Melanoma Before Laparoscopic Sampling. Surg Laparosc Endosc Percutan Tech 2008; 18:195-6. [DOI: 10.1097/sle.0b013e318169290c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frumovitz M, Gayed IW, Jhingran A, Euscher ED, Coleman RL, Ramirez PT, Levenback CF. Lymphatic mapping and sentinel lymph node detection in women with vaginal cancer. Gynecol Oncol 2008; 108:478-81. [DOI: 10.1016/j.ygyno.2007.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 11/30/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
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Dhar KK, DAS N, Brinkman DA, Beynon JL, Woolas RP. Utility of sentinel node biopsy in vulvar and vaginal melanoma: report of two cases and review of the literature. Int J Gynecol Cancer 2007; 17:720-3. [PMID: 17343569 DOI: 10.1111/j.1525-1438.2007.00885.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sentinel node (SN) biopsy is widely applied for treatment planning of cutaneous melanoma. However, using this strategy in female lower genital tract tumors has not yet been established. We report two cases, one each of vulvar and vaginal melanoma who underwent SN biopsy and review the available literature. Our experience and available limited evidence suggests that this low morbidity technique can be used for obtaining prognostic information and hence treatment planning for this disease. However, a false negative rate perhaps in the order of 15% suggests that careful consideration is necessary before using sentinel lymph node biopsy in the management of vulvar and vaginal melanoma.
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Affiliation(s)
- K K Dhar
- Department of Gynaecological Oncology, Saint Mary's Hospital, Portsmouth, United Kingdom.
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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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17
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Adib T, Barton DPJ. The sentinel lymph node: Relevance in gynaecological cancers. Eur J Surg Oncol 2006; 32:866-74. [PMID: 16765015 DOI: 10.1016/j.ejso.2006.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 03/23/2006] [Indexed: 10/24/2022] Open
Abstract
AIMS Sentinel lymph node (SLN) detection is widely practiced in the management of patients with malignant melanoma and beast cancer. Large studies on SLN detection and determination of nodal status have led to changes in the surgical management of the regional lymph nodes in these diseases. More recently attention has focused on other solid cancers, including gynaecological cancers. METHODS An extensive literature review of published reports on the SLN in gynaecological cancers was undertaken and the reports were categorised according to the level of evidence provided. RESULTS Vulva cancer is the most frequently investigated gynaecological cancer with regard to SLN detection because of its anatomical location and easily accessible nodal basin. Although there are no randomised controlled trials, some data suggest SLN detection in vulval cancer may alter clinical practice and reduce the number of groin lymphadenectomies. The lymphatic drainage of the other gynaecological organs is less predictable, the nodal basin less accessible or less well defined, the techniques not standardised and the evidence for the applicability of SLN detection in the management of these cancers is weak. CONCLUSION Sentinel lymph node detection in vulval cancer may reduce the need for radical groin lymphadenectomy and thereby reduce morbidity. SLN detection for other gynaecological cancers has little potential to alter clinical practice.
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Affiliation(s)
- T Adib
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, 4th Floor Lanesborough Wing, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
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Frumovitz M, Ramirez PT, Levenback C. Lymphatic mapping and sentinel node detection in gynecologic malignancies of the lower genital tract. Curr Oncol Rep 2005; 7:435-43. [PMID: 16221380 DOI: 10.1007/s11912-005-0008-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The utility of lymphatic mapping and sentinel lymph node biopsy in malignancies of the female lower genital tract-- vulvar, vaginal, and cervical cancers--is being explored in multiple centers internationally. For patients with these tumors, lymphatic mapping with sentinel lymph node biopsy holds the promise of increasing the identification of microscopically metastatic disease while decreasing the morbidity of complete lymphadenectomy. In this review article we present the published data on mapping techniques and discuss the advantages and pitfalls of these procedures.
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Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology, CPB6.3244, Unit 1362, The University of Texas M.D. Anderson Cancer Center, 1155 Herman Pressler, TX 77030, USA.
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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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Van Dam P, Sonnemans H, Van Dam PJ, Smet D, Verkinderen L, Dirix LY. Sentinel node detection in a patient with recurrent endometrial cancer initially treated by hysterectomy and radiotherapy. Int J Gynecol Cancer 2004; 14:673-6. [PMID: 15304164 DOI: 10.1111/j.1048-891x.2004.14422.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This is the first article reporting sentinel node identification in a patient with endometrial cancer recurring in the vagina. A 79-year-old woman presented with a midvaginal recurrence of a stage IB, grade II endometroid carcinoma that had been treated 3 years earlier by a total abdominal hysterectomy, bilateral salpingoophorectomy, and pelvic lymph node sampling, followed by adjuvant brachytherapy to the vaginal vault. A staging examination under anesthetic was performed. Preoperatively, 60-MBq technetium-labeled nannocolloid was injected in the mucosa at 3, 6, 9, and 12 o'clock just adjacent to the tumor recurrence. Three sentinel nodes were detected, respectively, in the left obturator fossa (two) and the right external iliac region, using a laparoscopic probe (Navigator) and removed for pathological assessment. As they proved to be negative, the patient underwent a total vaginectomy, parametrectomy with pelvic lymphadenectomy. The tumor was completely removed, and all lymph nodes proved to be negative. The accuracy of sentinel node identification in patients with recurrent gynecological tumors needs further evaluation. This unique case shows that sentinel node detection is possible after previous radiotherapy and surgery and hopes to stimulate further research in this field.
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Affiliation(s)
- P Van Dam
- Department of Obstetrics and Gynecology, Sint Augustinus Hospital, Antwerp, Belgium.
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Siu SSN, Lo KWK, Chan ABW, Yu MY, Cheung TH. Nodal detection in malignant melanoma of the vagina using laparoscopic ultrasonography. Gynecol Oncol 2004; 92:985-8. [PMID: 14984972 DOI: 10.1016/j.ygyno.2003.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary malignant melanoma of the vagina is a rare variant of melanoma. It has worse prognosis compared to nongenital melanomas or other vaginal malignant neoplasms. CASE A 40-year-old Chinese was diagnosed vaginal melanoma. Laparoscopic ultrasonography (USG) was used to search for abnormal pelvic and abdominal lymph nodes. Two metastatic pelvic lymph nodes were detected and excised. The vaginal tumour was removed by hysterectomy and partial vaginectomy. Despite a clear surgical margin and adjuvant radiotherapy, the patient died shortly after the operation. CONCLUSION Patient with vaginal melanoma has grave prognosis, especially when metastatic disease presents. Radical surgery appears unjustified as a routine, it is essential to exclude lymphatic and distant metastases before embark to radical surgery. This report presents the first case of laparoscopic ultrasonographic detection of metastatic pelvic lymph nodes in patient with vaginal melanoma.
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Affiliation(s)
- Shing-Shun N Siu
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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