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Guzik P, Łukasiewicz M, Harpula M, Zając P, Żmuda M, Śniadecki M, Topolewski P. Survival and Treatment Modalities in Primary Vaginal Melanoma-Case Report and a Narrative Review. J Clin Med 2024; 13:3771. [PMID: 38999339 PMCID: PMC11242499 DOI: 10.3390/jcm13133771] [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: 05/01/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Primary vaginal melanoma (PVM) is a rare cancer representing five percent of vaginal cancers and less than one percent of all female vaginal melanomas, with an incidence rate of 0.46 per million women per year. The aim of this study was to present a case of combined therapy and conservative surgical treatment in a young patient with PVM and to perform a systematic review of the same subject. Methods: We performed a narrative review of the literature and presented a case report. Results: The review yielded a total of 43 articles. We presented treatment modalities and survival outcomes. The presented case involved a combination of surgical treatment with adjuvant therapy comprising nivolumab and ipilimumab. Conclusions: PVM is a disease with a poor prognosis; however, new treatment options are promising and have a great chance of significantly improving survival. The combination of the wide local excision of the primary lesion followed by adjuvant therapies results in the best outcomes in the treatment of PVM. Future clinical studies are warranted to provide new evidence for the treatment outcomes of nonsurgical, metastatic PVM and the adjuvant treatment of PVM.
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Affiliation(s)
- Paweł Guzik
- Clinical Department of Gynecology and Obstetrics, City Hospital, 35-241 Rzeszów, Poland; (M.H.); (P.Z.)
| | - Martyna Łukasiewicz
- Medical University of Gdańsk, 17 Smoluchowskiego St., 80-241 Gdańsk, Poland; (M.Ł.); (P.T.)
| | - Magdalena Harpula
- Clinical Department of Gynecology and Obstetrics, City Hospital, 35-241 Rzeszów, Poland; (M.H.); (P.Z.)
| | - Paweł Zając
- Clinical Department of Gynecology and Obstetrics, City Hospital, 35-241 Rzeszów, Poland; (M.H.); (P.Z.)
| | - Marcin Żmuda
- Pathology Department, Clinical Provincial Hospital no 2, 35-241 Rzeszów, Poland;
| | - Marcin Śniadecki
- Department of Gynecology and Obstetrics, Medical University of Gdańsk, 17 Smoluchowskiego St., 80-241 Gdańsk, Poland;
| | - Paweł Topolewski
- Medical University of Gdańsk, 17 Smoluchowskiego St., 80-241 Gdańsk, Poland; (M.Ł.); (P.T.)
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Sticca G, Misheva B, Sebajang H, Samouelian V, Jamal R. Primary malignant melanoma of the vagina: A case report. Gynecol Oncol Rep 2023; 49:101266. [PMID: 37727370 PMCID: PMC10505967 DOI: 10.1016/j.gore.2023.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
Malignant primary melanoma of the vagina (PMV) is a rare type of non-cutaneous melanoma often discovered in postmenopausal women. PMV has a very aggressive disease course and a poor prognosis. The best course of treatment is not presently agreed upon. In this report, we describe the case of a 68-year-old woman presenting with a malignant PMV and its subsequent management. The patient presented with right vaginal pain, abnormal vaginal bleeding and a new vaginal mass. A PET scan identified a 28 × 38 mm hypermetabolic vaginal lesion, without nodal involvement or distant metastasis. A posterior exenteration type 2B was performed, including the anal mucosa. Sentinel lymph node dissection, vaginal and rectal resection as well as a terminal colostomy were also carried out. Final staging was FIGO stage III and T4bN1. Four months later, the patient presented with a recurrent vaginal bleed and intra-vaginal induration. Imaging revealed loco-reginal recurrence at the site of the primary malignancy with countless metastases. The patient opted for palliative care given the early disseminated recurrence and her multiple comorbidities. We review the treatment options for PMV, mainly the importance of surgery as the mainstay of treatment as well as the interest of adding checkpoint inhibitor immunotherapy or targeted therapy to the treatment plan. We also summarize the characteristics of PMV and its main prognostic factors.
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Affiliation(s)
- Giancarlo Sticca
- Centre Hospitalier Universitaire de Montréal, Département de chirurgie générale, Canada
| | - Bojana Misheva
- Centre Hospitalier Universitaire de Montréal, Département de chirurgie générale, Canada
| | - Herawaty Sebajang
- Centre Hospitalier Universitaire de Montréal, Département de chirurgie générale, Canada
| | - Vanessa Samouelian
- Centre Hospitalier Universitaire de Montréal, Département de gynécologie oncologique, Canada
| | - Rahima Jamal
- Centre Hospitalier Universitaire de Montréal, Département d’hématologie oncologie, Canada
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3
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Shrestha R, Devkota K, Thapa BD, Dahal M, Silwal SR, Dulal S, Regmi MC, Ortiz BH. Multimodality treatment of a primary vulvar melanoma in a low resource setting: A case report. Gynecol Oncol Rep 2023; 47:101206. [PMID: 37293352 PMCID: PMC10244899 DOI: 10.1016/j.gore.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/20/2023] [Indexed: 06/10/2023] Open
Abstract
Primary vulvar melanoma is a rare but highly aggressive malignant neoplasm accounting for 1-2 % of all malignant melanoma and 5-10 % of all vulvar cancers in females. Here we report a case of 32 years old female diagnosed with primary vulvar melanoma during the evaluation of a two cm growth in the inner labia minora on the right side. She underwent wide local excision with excision of the distal one cm of the urethra and bilateral groin node dissection. The final histopathology was vulvar malignant melanoma with 1 out of 15 groin nodes involved but all resected margins were free of tumor. The final surgical stage was T4bN1aM0 (8th AJCC TNM) and IIIC (FIGO). She received adjuvant radiotherapy followed by 17 cycles of Pembrolizumab. To date, she is both clinically and radiologically disease free with a progression-free survival of 9 months.
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Affiliation(s)
- Ramesh Shrestha
- Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Karun Devkota
- Department of Radiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Baburam Dixit Thapa
- Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mona Dahal
- Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sudhir Raj Silwal
- Department of Radiation Oncology, Bhaktapur Cancer Hospital, Kathmandu, Nepal
| | - Soniya Dulal
- Department of Medical Oncology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mohan Chandra Regmi
- Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Beverly Hannah Ortiz
- Sound Gynecologic Oncology, PLLC, 20 Riverleigh Ave, Suite 2B, Riverhead, NY 11901, USA
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Van Trappen P, Lebbe I, De Cuypere E, Claes N. Case report: a robotic-vaginal approach for total vaginectomy and hysterectomy with pelvic sentinel lymph node dissection in primary vaginal melanoma: a 10-step technique and literature review. Front Surg 2023; 10:1189196. [PMID: 37304184 PMCID: PMC10250735 DOI: 10.3389/fsurg.2023.1189196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Primary vaginal melanoma is extremely rare, has a poor prognosis, and occurs mostly in elderly women. The diagnosis is based on histology and immunohistochemistry of a biopsy. Given the rarity of vaginal melanoma, no standardized treatment guidelines are established; however, surgery is the primary treatment modality in the absence of metastatic disease. Most reports in the literature are retrospective single cases, case series, and population-based studies. The open surgical approach is the main modality reported. Here, we report for the first time a 10-step combined robotic-vaginal technique, with en bloc resection of the uterus and total vagina, for treating clinically early-stage primary vaginal melanoma. In addition, the patient in our case underwent a robotic pelvic bilateral sentinel lymph node dissection. The literature on the surgical approach for vaginal melanoma is reviewed. Case presentation A 73-year-old woman was referred to our tertiary cancer center and was clinically staged according to the 2009 International Federation of Gynaecology and Obstetrics (FIGO) staging for vaginal cancer as FIGO-stage I (cT1bN0M0) and according to the American Joint Committee on Cancer (AJCC) for (cutaneous) Melanoma Staging as clinical stage IB. Preoperative imaging with magnetic resonance imaging, FDG-positron emission tomography-computed tomography, and ultrasound of the groins did not reveal any adenopathy nor metastases. The patient was planned for a combined vaginal and robotic en bloc total vaginectomy and hysterectomy, as well as a pelvic bilateral sentinel lymph node dissection. Results The surgical procedure was performed in 10 steps described in this case report. The pathology revealed free surgical margins and negative test results for all sentinel lymph nodes. The postoperative recovery process was uneventful, and the patient was discharged on day 5. Conclusion The main surgical approach reported for primary early-stage vaginal melanoma is open surgery. A minimally invasive surgical approach, described here as a combined vaginal-robotic en bloc total vaginectomy and hysterectomy, for the surgical treatment of early-stage vaginal melanoma enables precise dissection, low surgical morbidity, and fast recovery for the patient.
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Affiliation(s)
- Philippe Van Trappen
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Ines Lebbe
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Eveline De Cuypere
- Department of Medical Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Nele Claes
- Department of Medical Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
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Mitra D, Farr M, Nagarajan P, Ho J, Bishop AJ, Jhingran A, Farooqi AS, Frumovitz M, Amaria RN, McQuade JL, Jazaeri AA, Guadagnolo BA. Gynecologic tract melanoma in the contemporary therapeutic era: High rates of local and distant disease progression. Gynecol Oncol 2022; 167:483-489. [PMID: 36229264 DOI: 10.1016/j.ygyno.2022.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Gynecologic tract melanoma (GTM) is a rare malignancy with historically poor outcomes. The current study examines patterns of care and oncologic outcomes in a large single-institution cohort from the contemporary therapeutic era. METHODS Patterns of care and predictors of outcomes were evaluated for all GTM patients without metastatic disease at diagnosis who were treated at our institution between 2009 and 2020 with >6 months of follow-up. RESULTS Of the 124 patients included, anatomic subsites were vulvar (n = 82, 66%), vaginal (n = 34, 27%), or cervical (n = 8, 6%). Primary tumor was resected for 85% (n = 106) with surgical nodal evaluation for 60% (n = 75). Systemic therapy, most commonly immune checkpoint inhibitors (ICI, 58% systemic therapy), was used to treat all except one unresectable patient (17/18) and 33% (35/106) of resectable patients. Seven patients received neoadjuvant ICI. Fourteen patients received adjuvant radiation therapy to the pelvis (RT, 13% of those undergoing resection). With a median follow-up of 45 months, 100 patients (81%) recurred. Four-year actuarial outcomes were: 46% local control, 53% nodal control, 36% distant metastasis-free survival, 17% disease-free survival, 49% melanoma-specific survival and 48% overall survival. Mitotic rate > 10/mm2, nodal involvement and non-vulvar anatomic subsite were associated with poor outcomes. Patients treated after 2016 did not have significantly better outcomes than those treated earlier. CONCLUSIONS Patients with GTM continue to have poor outcomes in the contemporary therapeutic era with particularly notable poor local disease control relative to other mucosal melanoma subtypes. More effective oncologic therapy is needed.
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Affiliation(s)
- Devarati Mitra
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Morgan Farr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joel Ho
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer, Houston, TX, USA Center, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahsan S Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer, Houston, TX, USA Center, USA
| | - Jennifer L McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer, Houston, TX, USA Center, USA
| | - Amir A Jazaeri
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Radiotherapy and Immunotherapy, Combined Treatment for Unresectable Mucosal Melanoma with Vaginal Origin. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gynecologic melanomas are uncommon and malignant mucosal melanomas with vaginal origin are extremely rare, treatment strategies are limited and extrapolated from those of cutaneous melanoma. A better understanding of the vulvovaginal melanoma’s biology and its risk factors is needed. Therapeutic strategies include surgery, systemic therapy and radiotherapy. For vulvovaginal melanoma, surgery is selected as the primary treatment. Immunotherapy and target treatment have recently enhanced the systemic therapy for cutaneous melanoma (CM). Immunotherapy and new target agents demonstrated a better survival of melanoma and might be considered as treatment of vulvovaginal melanoma. Radiotherapy is included in the therapeutic arsenal for mucosal melanoma and may be performed on selected patients who may receive concurrent checkpoints and inhibition neoadjuvant radiotherapy with the purpose of reducing morbidity and mortality.
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7
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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. [DOI: 10.1016/j.ajur.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
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Clinical Outcomes of Radiotherapy in Vaginal and Vulvar Melanoma: A High-volume Centre's Experience With a Rare Disease. Clin Oncol (R Coll Radiol) 2022; 34:e365-e366. [PMID: 35660065 DOI: 10.1016/j.clon.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
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9
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Cui C, Lian B, Zhang X, Wu D, Li K, Si L, Yang Y, Tian H, Zhou L, Chi Z, Sheng X, Kong Y, Mao L, Wang X, Bai X, Yan X, Li S, Dai J, Tang B, Wei X, Gershenwald JE, Balch CM, Guo J. An Evidence-Based Staging System for Mucosal Melanoma: A Proposal. Ann Surg Oncol 2022; 29:5221-5234. [DOI: 10.1245/s10434-022-11670-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
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10
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Tian H, Wang X, Lian B, Si L, Gao M, Zheng H, Chi Z, Kong Y, Mao L, Bai X, Tang B, Yan X, Li S, Zhou L, Dai J, Sun Y, Wu L, Guo J, Cui C. Surgical Outcomes of Vaginal or Cervical Melanoma. Front Surg 2022; 8:771160. [PMID: 35047550 PMCID: PMC8761811 DOI: 10.3389/fsurg.2021.771160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the effectiveness of radical resection compared with non-radical resection for vaginal or cervical melanoma. Methods: We retrospectively analysed the clinical data of post-operative patients with primary lower genital tract melanoma hospitalised at Peking University Cancer Hospital between Jan 2014 and Dec 2020. The study endpoints were recurrence-free survival (RFS) and overall survival (OS). Kaplan–Meier method-plotted survival curves and univariate and multivariate Cox proportional hazards regression models were used to identify the factors associated with RFS and OS, and to calculate hazard ratios (HRs) and associated 95% confidence intervals (95% CIs). Results: A total of 80 patients were included. Thirty-one patients had received non-radical resection, and 49 patients had received radical resection. The median patient age was 55.5 (IQR 45.3–60.0) years. Sixty-two (77.5%) patients had vaginal melanoma. Sixty-four patients (80.0%) had received post-operative adjuvant therapy. The median follow-up time was 36.0 months (95% CI 10.1–62.1 months). Sixty-four patients developed recurrence, and 44 patients died. The median RFS (mRFS) was 6.0 months (95% CI 3.4–8.6 m), and the RFS for the radical resection group was longer than that for the non-radical resection group (9.5 vs. 5.3 m), with no significant difference (P > 0.05). The median OS (mOS) was 25.9 months (95% CI 14.4–37.4 m). The mOS was 24.6 months (95% CI 10.3–38.9 m) and 25.9 months (95% CI 10.9–40.9 m) in the non-radical resection group and the radical resection group, respectively. Multivariate Cox regression analysis showed that surgical approach, infiltration depth of the tumour, lymph node metastasis, and post-operative adjuvant therapy were independent risk factors for RFS and that post-operative adjuvant therapy was an independent risk factor for OS. Conclusion: By performing multivariate analysis, which corrected for potential confounding factors, we identified surgical procedures that were associated with RFS, and we found that RFS and OS in patients with vaginal melanoma and cervical melanoma benefitted from post-operative adjuvant therapy.
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Affiliation(s)
- Hui Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Min Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gynecologic Oncology, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Hong Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gynecologic Oncology, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Yangchun Sun
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
- *Correspondence: Chuanliang Cui
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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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12
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Saleh M, Javadi S, Elsherif S, Patnana M, Sagebiel TL, Torres-Cabala C, Matei J, Bhosale P, Faria SC. Multimodality Imaging and Genetics of Primary Mucosal Melanomas and Response to Treatment. Radiographics 2021; 41:1954-1972. [PMID: 34678102 DOI: 10.1148/rg.2021210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mucosal melanomas (MMs) are rare and aggressive tumors that arise from melanocytes in the mucosal tissues that line the respiratory, gastrointestinal, and urogenital tracts. Most MMs occur during the 6th and 7th decades of life. MMs may be asymptomatic but may also cause bleeding, pain, and itching, depending on the site of origin. Because of their asymptomatic or oligosymptomatic nature and the difficulty of visualizing them in some cases, they are often advanced tumors at patient presentation. MM staging varies depending on the site of the primary tumor. A simplified staging system allows classification of clinically localized disease as stage I, regional nodal involvement as stage II, and distant metastasis as stage III. MM differs genetically from its cutaneous counterparts. Common drivers in cutaneous melanoma such as B-raf proto-oncogene serine/threonine kinase (BRAF) have a lower mutation rate in MM, whereas mutations of other genes including the KIT proto-oncogene, receptor tyrosine kinase (KIT) and splicing factor 3b subunit 1 gene (SF3B1) are more common in MM. Complete resection is the best curative option. However, surgical intervention with wide local excision and negative margins may be difficult to attain because of the local anatomy and the extent of disease. In addition, despite aggressive surgical resection, most patients develop local recurrence and metastatic disease. Recent advances in the treatment of melanoma include immunotherapy and targeted therapy. Unfortunately, MMs have a relatively poor prognosis, with an overall 5-year survival rate of 25%. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mohammed Saleh
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sanaz Javadi
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sherif Elsherif
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Madhavi Patnana
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Tara L Sagebiel
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Carlos Torres-Cabala
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Jane Matei
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Priya Bhosale
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Silvana C Faria
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
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13
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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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14
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Guo N, Zhang J. Primary vaginal malignant melanoma: A rare case report of successful treatment with nivolumab. Medicine (Baltimore) 2021; 100:e25691. [PMID: 33907144 PMCID: PMC8084096 DOI: 10.1097/md.0000000000025691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Primary vaginal malignant melanoma is a sporadic and very aggressive tumor that is treated through surgery or radiotherapy combined with chemotherapy. Since most cases are diagnosed at an advanced stage, the operation range is extensive, the quality of life is poor, and the prognosis is gloomy. PATIENT CONCERNS A 58-year-old woman presented irregular water-like leukorrhea for 1 month after 6 years of menopause. Positron emission tomography-computed tomography revealed a 3.1 × 2.6 × 3.2 mass on the middle and lower part of the right vaginal wall. A gynecological examination revealed a 2 to 3 cm exophytic black mass in the lower-right part of the vaginal orifice. This mass was 2 cm from the urethral orifice. Furthermore, the mucosa of the anterior inferior vaginal wall had blackened and thickened, and there were some scattered black dots at the medial labia minora. DIAGNOSIS Due to the patient's symptoms with radiographic findings, the postmenopausal woman was diagnosed with primary vaginal malignant melanoma. INTERVENTIONS Surgery was done to remove the mass. The patient also underwent inguinal lymph node dissection, received immunotherapy, and was treated with nivolumab. OUTCOMES After a 6-month follow-up period, the patient underwent a routine gynecological examination with negative radiological results. Moreover, no local recurrence or distant metastases were found. LESSONS This patient showed a good response to immunotherapy. With this treatment method, the prognosis is better for advanced-stage women, especially those who cannot endure the surgery. Local lesion resection and inguinal lymph node dissection combined with immunotherapy are recommended. The case reported here may help treat similar clinical cases.
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Affiliation(s)
- Na Guo
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Jiawen Zhang
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
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15
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Sezen D, Patel RR, Tang C, Onstad M, Nagarajan P, Patel SP, Welsh JW, Lin LL. Immunotherapy combined with high- and low-dose radiation to all sites leads to complete clearance of disease in a patient with metastatic vaginal melanoma. Gynecol Oncol 2021; 161:645-652. [PMID: 33795130 DOI: 10.1016/j.ygyno.2021.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 73-year-old woman with metastatic vaginal mucosal melanoma that had progressed on ipilimumab and nivolumab experienced clinical and radiographic complete response to dual checkpoint inhibitor immunotherapy given in combination with high-dose plus low-dose radiation. General characteristics and treatment options in this disease are highlighted.
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Affiliation(s)
- Duygu Sezen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Roshal R Patel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Albany Medical College, Albany, NY, USA
| | - Christine Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Michaela Onstad
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sapna P Patel
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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16
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Joste M, Dion L, Brousse S, Nyangoh Timoh K, Rousseau C, Reilhac A, Laviolle B, Lesimple T, Lavoue V, Leveque J. Vulvar and vaginal melanomas: A retrospective study spanning 19 years from a tertiary center. J Gynecol Obstet Hum Reprod 2021; 50:102091. [PMID: 33592345 DOI: 10.1016/j.jogoh.2021.102091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Mucosal melanomas (MM) of the female genital tract are rare a. We aimed to study the prognostic factors of vulvar and vaginal locations of MM. MATERIAL AND METHOD A multicenter, retrospective cohort study conducted between 01/01/2000 and 01/06/2019. RESULT Of the 33 patients included 25 (75.8 %) had vulvar (VuM) and eight (24.2 %) vaginal melanomas (VaM). VaMs were deeper: median Breslow index: 17.5mm [3.5-22] versus 4.3mm [0.35-18] (p=0.013). Average follow-up was 24.0±59.8 months. Twenty-six patients (78.8 %) experienced recurrence. Disease-free survival was 52.9 % at 1year (64.7 % for VuM and 14.3 % for VaM) and 8.4 % at 3 years (11 % for VuM and 0% for VaM) (p=0.002). Median time to the first recurrence was 9.01 months [CI95 %: 2.07-56.71]. VaM recurred earlier than VuM (3.12 months [CI95 %: 2.07-12.49] versus 17.72 [CI95 %: 3.58-56.71], p=0.011). VaM had a higher risk of recurrence (HR=5.64 [CI95 %: 2.01-15.82], p=0.001) in multivariate analysis. Overall survival was 88.5 % at 1year (100 % for VuM and 50 % for VaM), and 59.4 % at 3 years (69.3 % for VuM and 25 % for VaM). Women with VaM died earlier: median specific death occurrence of 8.76 months [CI95 %: 6.54-24.72] versus 39.61 [CI95 %: 21.89-209.21], p=0.013 (HR=5.08 [CI95 %: 1.39-18.60], p=0.014). A lesion size ≥3cm was associated with an increased risk of mortality (HR=8.45 [CI95 %: 1.60-44.52], p=0.012). In multivariate analysis, vaginal location remained an independent and predictive variable of a higher risk of specific death (HR=8.56 [CI95 %: 1.95-37.64], p=0.005). CONCLUSION A vaginal location of MM is associated with a poorer prognosis than a vulvar location.
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Affiliation(s)
- Marine Joste
- Gynecology Unit, CHU Rennes, 16 Bd de Bulgarie, BP 90 347, 35203, RENNES Cedex 2, France
| | - Ludivine Dion
- Gynecology Unit, CHU Rennes, 16 Bd de Bulgarie, BP 90 347, 35203, RENNES Cedex 2, France
| | - Susie Brousse
- Gynecology Unit, CHU Rennes, 16 Bd de Bulgarie, BP 90 347, 35203, RENNES Cedex 2, France
| | - Krystel Nyangoh Timoh
- Gynecology Unit, CHU Rennes, 16 Bd de Bulgarie, BP 90 347, 35203, RENNES Cedex 2, France
| | - Chloé Rousseau
- Clinical Pharmacology Unit, CHU Pontchaillou, 2 rue Henri Le Guilloux, BP 35 033, RENNES Cedex 9, France
| | - Astrid Reilhac
- Clinical Pharmacology Unit, CHU Pontchaillou, 2 rue Henri Le Guilloux, BP 35 033, RENNES Cedex 9, France
| | - Bruno Laviolle
- Clinical Pharmacology Unit, CHU Pontchaillou, 2 rue Henri Le Guilloux, BP 35 033, RENNES Cedex 9, France
| | - Thierry Lesimple
- Medical Oncology, CRLCC Centre Eugène Marquis, Avenue de la Bataille Flandre-Dunkerque, CS 44 229, 35042, RENNES Cedex 9, France
| | - Vincent Lavoue
- Gynecology Unit, CHU Rennes, 16 Bd de Bulgarie, BP 90 347, 35203, RENNES Cedex 2, France.
| | - Jean Leveque
- Gynecology Unit, CHU Rennes, 16 Bd de Bulgarie, BP 90 347, 35203, RENNES Cedex 2, France
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17
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Zhou WL, Yue YY. Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study. Front Oncol 2020; 10:570933. [PMID: 33392073 PMCID: PMC7775586 DOI: 10.3389/fonc.2020.570933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort. Methods We performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan-Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied. Results Of the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62-0.82, p < 0.001; adjusted HR = 0.73, 95% CI 0.63-0.84, p < 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69-0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69-0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p < 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT. Conclusion RTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Tokumitsu R, Hirakawa T, Yano M, Kirakosyan E, Sato S, Nasu K, Narahara H. A Case of Vaginal Malignant Melanoma Completely Resected by Radical Surgery. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927462. [PMID: 33085655 PMCID: PMC7588352 DOI: 10.12659/ajcr.927462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Female, 56-year-old Final Diagnosis: Malignant melanoma Symptoms: Tumor Medication:— Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Ryuichi Tokumitsu
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Tomoko Hirakawa
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Mitsutake Yano
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan.,Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan
| | - Evgeniya Kirakosyan
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan.,International School "Medicine of the Future", Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Shimpei Sato
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan.,Division of Obstetrics and Gynecology, Support System for Community Medicine, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, Japan
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19
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Paravathaneni M, Edlukudige Keshava V, Baralo B, Thirumaran R. Primary Vaginal Malignant Melanoma: A Case Report and Review of Literature. Cureus 2020; 12:e10536. [PMID: 33094076 PMCID: PMC7574980 DOI: 10.7759/cureus.10536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Primary vaginal malignant melanoma is an extremely rare and aggressive tumor with very few reported cases worldwide. It often occurs in post-menopausal women, with a mean age of 57 years. The most common presenting symptom is vaginal bleeding. Other less common presenting symptoms are vaginal discharge, vaginal mass, and pain. Vaginal melanomas are often diagnosed at an advanced stage, and despite the aggressive treatment approach, the prognosis is poor. We present to you a case of a 56-year-old post-menopausal woman who presented with intermittent vaginal bleeding and passage of dark clots. She was found to have symptomatic anemia requiring blood transfusions. Further workup revealed a mass in the upper vagina on imaging studies, and the patient eventually underwent a biopsy, which confirmed the diagnosis of malignant melanoma of the vagina on pathological examination.
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20
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Zhou W, Yue Y, Pei D. Survival benefit of vaginectomy compared to local tumor excision in women with FIGO stage I and II primary vaginal carcinoma: a SEER study. Arch Gynecol Obstet 2020; 302:1429-1439. [PMID: 32780160 DOI: 10.1007/s00404-020-05737-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The effectiveness of vaginectomy compared to that of local tumor excision (LTE) for the International Federation of Gynecology and Obstetrics (FIGO) stage I and II vaginal carcinoma is unclear. We aimed to clarify if the effectiveness of vaginectomy is comparable to that of LTE in the real world. METHODS We retrospectively evaluated data of patients with primary vaginal carcinoma registered in the Surveillance, Epidemiology, and End Results Program (SEER) database from 2004 to 2016. The multivariate Cox proportional hazards models and Fine-Gray competing risk models were used to estimate the overall survival (OS) and disease-specific survival (DSS) after propensity score matching. RESULTS Of the 533 patients with FIGO stage I and II primary vaginal carcinoma, 243 and 290 patients were treated with vaginectomy and LTE, respectively. Vaginectomy was significantly associated with improved OS [unadjusted hazard ratio (HR) = 0.70, 95% confidence interval (CI) 0.53-0.95, P = 0.020; adjusted HR = 0.63, 95% CI 0.46-0.87, P = 0.005] and DSS [unadjusted subdistribution HR (sHR) = 0.75, 95% CI 0.52-1.07, P = 0.115; adjusted sHR = 0.65, 95% CI 0.44-0.97, P = 0.036]. Age, marital status, histology type, FIGO stage, chemotherapy, and lymph node metastases were significant prognostic factors of survival. Moreover, radiotherapy did not influence the effectiveness of vaginectomy. Subgroup and sensitivity analysis confirmed the consistent beneficial effectiveness of vaginectomy. CONCLUSION Compared with LTE, vaginectomy results in significantly prolonged survival in patients with FIGO stage I and II primary vaginal carcinoma. Thus, it can be the preferred treatment for FIGO I and II vaginal cancer regardless of radiotherapy status.
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Affiliation(s)
- Weili Zhou
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yangyang Yue
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China. .,Department of Family Medicine, Shengjing Hospital, China Medical University, Shenyang, China.
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21
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Li C, Zhang Q, Li Z, Feng S, Luo H, Liu R, Wang L, Geng Y, Zhao X, Yang Z, Li Q, Yang K, Wang X. Efficacy and safety of carbon-ion radiotherapy for the malignant melanoma: A systematic review. Cancer Med 2020; 9:5293-5305. [PMID: 32524777 PMCID: PMC7402834 DOI: 10.1002/cam4.3134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022] Open
Abstract
Malignant melanomas (MMs) were the fifth most common cancer in men and the sixth most common cancer in women in 2018, respectively. These are characterized by high metastatic rates and poor prognoses. We systematically reviewed safety and efficacy of carbon-ion radiotherapy (CIRT) for treating MMs. Eleven studies were eligible for review, and the data showed that MM patients showed better local control with low recurrence and mild toxicities after CIRT. Survival rates were slightly higher in patients with cutaneous or uveal MMs than in those with mucosal MMs. CIRT in combination with chemotherapy produced higher progression-free survival rates than CIRT only. In younger patients, higher rates of distant metastases of gynecological MMs were observed. The data indicated that CIRT is effective and safe for treating MMs; however, a combination with systemic therapy is recommended to ensure the best possible prognosis for MMs.
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Affiliation(s)
- Chengcheng Li
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Qiuning Zhang
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
- Lanzhou Heavy Ions HospitalLanzhouChina
| | - Zheng Li
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Shuangwu Feng
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Hongtao Luo
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Ruifeng Liu
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Lina Wang
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Yichao Geng
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Xueshan Zhao
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Zhen Yang
- Basic Medical CollegeLanzhou UniversityLanzhouChina
| | - Qiang Li
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Kehu Yang
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouChina
| | - Xiaohu Wang
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
- Lanzhou Heavy Ions HospitalLanzhouChina
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22
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Lin W, Song P, Ran X, Li R, Jiang X. A successfully treated malignant melanoma arising in a large congenital vulvar blue nevus. Dermatol Ther 2020; 33:e13821. [PMID: 32531081 DOI: 10.1111/dth.13821] [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: 12/06/2019] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
An atypical cellular blue nevus, a benign mass, may sometimes transform into a malignant melanoma. Here, we report a rare case of melanoma arising in a large congenital vulvar blue nevus. A 28-year-old Chinese woman presented to our hospital with a chief complaint of a vulvar mass that had persisted for 8 years. The patient underwent extensive local excision, followed by reconstructive surgery of the female reproductive tract. The mass was diagnosed as being a vulvar malignant melanoma. Postoperatively, the patient received interferon immunotherapy and recovered without complications. No evidence of recurrence was observed after 32 months of follow-up. Our case thus shows that comprehensive treatment with surgery supplemented by immunotherapy can be effective against a malignant melanoma arising in a vulvar blue nevus.
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Affiliation(s)
- Weizhao Lin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Pingping Song
- The First Clinical Medical College of Jinan University, Guangzhou, Guangdong, China
| | - Xiaoxia Ran
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Ruiman Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xuefeng Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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23
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Pandey G, Dave P, Patel S, Patel B, Arora R, Parekh C, Begum D. Female genital tract melanoma: Analysis from a regional cancer institute. Turk J Obstet Gynecol 2020; 17:46-51. [PMID: 32341830 PMCID: PMC7171547 DOI: 10.4274/tjod.galenos.2020.44789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: Malignant melanoma of the genital tract comprises 3% of all melanomas afflicting females. They are characterized by poor prognosis with 5-year survival of 0-25% and high incidence for distant metastasis. This study was performed to assess various clinical features, treatment options, and thre management of genital melanomas. Materials and Methods: This was a retrospective analysis where records of patients with genital melanomas between 2005 to 2018 were reviewed to obtain demographic and clinical information, including age of diagnosis, presenting symptoms, performance status, pathology reports, treatment, follow-up, and survival. Results: Between 2005 and 2018, 31 women were analyzed. The median age was 53.5 (range: 28.5-85) years. Vaginal bleeding was the most common presenting symptom (80.6%), followed by discharge (29%), mass in the vagina/perineum (19.3%), pain (16.1%), and difficulty in micturition (9.6%). The most common site of origin was the vagina (67.7%), followed by that vulva (19.3%) and cervix (12.9%). Tumor diameter was more than 3 cm in 74.2% (23/31). Out of 31 patients, only 16 opted for treatment. Four patients underwent surgery, 10 received primary chemotherapy, and two needed palliative radiotherapy for heavy bleeding. The median survival in the treatment group was 5 (range: 2.5-28) months, almost similar to patients not receiving any treatment (5 months, range: 2-11). Conclusion: Genital melanoma are rare but aggressive tumors. Diagnosis is usually made with biopsy. No effective treatment strategy is yet available. However, surgery is the preferred first- line treatment, radiotherapy and chemotherapy have been used in adjuvant settings.
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Affiliation(s)
- Garima Pandey
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
| | - Pariseema Dave
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
| | - Shilpa Patel
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
| | - Bijal Patel
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
| | - Ruchi Arora
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
| | - Chetna Parekh
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
| | - Dimpy Begum
- Gujarat Cancer and Research Institute, Clinic of Gynae Oncology, Ahmadabad, India
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24
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Abstract
Primary malignant melanoma of the vagina is a rare gynaecological neoplasm with an aggressive course of disease. Although not many cases have been reported in the literature, its manifestations appear to be fairly consistent. The challenge comes in knowing how to approach this cancer clinically, since information about its staging and treatment is limited. In this report, we present a case of an 84-year-old postmenopausal woman in whom a suspicious vaginal lesion was discovered incidentally during a procedure. Wide local excision was carried out at a later date and histopathology confirmed a malignant melanoma of the vagina contained locally with no radiological finding of distant metastases. No additional treatment was given, and three monthly follow-ups were arranged for this patient. We review the literature and briefly discuss the epidemiology, treatment approaches, prognostic factors and expected outcomes of this rare disease.
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Affiliation(s)
- Emily Jamaer
- Obstetrics and Gynecology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Zach Liang
- Obstetrics and Gynecology, Flinders University, Adelaide, South Australia, Australia
| | - Brendan Stagg
- Pathology, Flinders Cancer Clinic, Bedford Park, South Australia, Australia
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Predictive biomarkers and tumor microenvironment in female genital melanomas: a multi-institutional study of 55 cases. Mod Pathol 2020; 33:138-152. [PMID: 31383965 DOI: 10.1038/s41379-019-0345-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023]
Abstract
Female genital melanomas are rare. At diagnosis, most affected patients have advanced disease. Surgery remains the primary treatment, and adjuvant therapy is largely ineffective. Recently, immune checkpoints and the mitogen-activated protein kinase pathway have been explored as treatment targets. However, evaluation of these biomarkers in genital melanomas is limited. We evaluated the clinicopathological features of 20 vulvar, 32 vaginal, and three cervical melanomas and assessed programmed cell death ligand 1 (PD-L1) expression, CD8 tumor-infiltrating lymphocyte density, mismatch repair proteins, VE1 immunohistochemistry, and KIT and BRAF mutations. The median age of the patients was 66 years, and median tumor sizes were 25, 30, and 20 mm for vulvar, vaginal, and cervical tumors, respectively. Mean mitotic figures were 18, 19, and 30 per mm2. Thirty-seven patients (67%) had operable tumors. After a median follow-up of 15 months, only nine patients (16%) were alive. Eight of the nine survivors did not have lymph node metastasis. Using 5% as the threshold, PD-L1 expression was observed in 55%, 50%, and 33% of vulvar, vaginal, and cervical tumors, respectively, when the Roche SP263 antibody was used and 20%, 53%, and 0%, respectively, when the Dako 28-8 antibody was used. The median CD8 tumor-infiltrating lymphocyte density was significantly higher in vulvar/vaginal than cervical melanomas and correlated with PD-L1 expression. No cases exhibited loss of mismatch repair proteins. Five cases harbored KIT mutations, three of which were hotspots. BRAF V600E mutation was not detected. Univariable analysis showed that tumor size greater than or equal to 33 mm, mitotic figures of greater than or equal to 10 per mm2, lymph node metastasis, and low CD8+ tumor-infiltrating lymphocyte density were adverse prognostic factors. Thus, patients with genital melanomas have a poor prognosis, and evaluation of multiple biomarkers is necessary to identify patients who may benefit from immunotherapy or targeted therapy.
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Wang H, Wu X, Zhang X, Yang X, Long Y, Feng Y, Wang F. Prevalence of NRAS Mutation, PD-L1 Expression and Amplification, and Overall Survival Analysis in 36 Primary Vaginal Melanomas. Oncologist 2019; 25:e291-e301. [PMID: 32043781 PMCID: PMC7011659 DOI: 10.1634/theoncologist.2019-0148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/21/2019] [Indexed: 12/22/2022] Open
Abstract
Background Primary vaginal melanomas are uncommon and aggressive tumors with poor prognosis, and the development of new targeted therapies is essential. This study aimed to identify the molecular markers occurring in these patients and potentially improve treatment strategies. Materials and Methods The clinicopathological characteristics of 36 patients with primary vaginal melanomas were reviewed. Oncogenic mutations in BRAF, KIT, NRAS, GNAQ and GNA11 and the promoter region of telomerase reverse transcriptase (TERT) were investigated using the Sanger sequencing. The expression and copy number of programmed death‐ligand 1 (PD‐L1) were also assessed. Results Mutations in NRAS, KIT, and TERT promoter were identified in 13.9% (5/36), 2.9% (1/34), and 5.6% (2/36) of the primary vaginal melanomas, respectively. PD‐L1 expression and amplification were observed in 27.8% (10/36) and 5.6% (2/36) of cases, respectively. PD‐L1 positive expression and/or amplification was associated with older patients (p = .008). Patients who had NRAS mutations had a poorer overall survival compared with those with a wild‐type NRAS (33.5 vs. 14.0 months; hazard ratio [HR], 3.09; 95% CI, 1.08–8.83). Strikingly, two patients with/without PD‐L1 expression receiving immune checkpoint inhibitors had a satisfying outcome. Multivariate analysis demonstrated that >10 mitoses per mm2 (HR, 2.96; 95% CI, 1.03–8.51) was an independent prognostic factor. Conclusions NRAS mutations and PD‐L1 expression were most prevalent in our cohort of primary vaginal melanomas and can be potentially considered as therapeutic targets. Implications for Practice This study used the Sanger sequencing, immunohistochemistry, and fluorescence in situ hybridization methods to detect common genetic mutations and PD‐L1 expression and copy number in 36 primary vaginal melanomas. NRAS mutations and PD‐L1 expression were the most prevalent, but KIT and TERT mutations occurred at a lower occurrence in this rare malignancy. Two patients receiving immune checkpoint inhibitors had a satisfying outcome, signifying that the PD‐L1 expression and amplification can be a possible predictive marker of clinical response. This study highlights the possible prospects of biomarkers that can be used for patient selection in clinical trials involving treatments with novel targeted therapies based on these molecular aberrations. Little is known about the molecular characteristics of primary vaginal melanoma. This article reports on the molecular markers of this rare and aggressive disease, focusing on improvements in treatment strategies.
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Affiliation(s)
- Hai‐Yun Wang
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Molecular Diagnostics, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
| | - Xiao‐Yan Wu
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Molecular Diagnostics, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
| | - Xiao Zhang
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Molecular Diagnostics, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
| | - Xin‐Hua Yang
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Molecular Diagnostics, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
| | - Ya‐Kang Long
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Molecular Diagnostics, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
| | - Yan‐Fen Feng
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Pathology, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
| | - Fang Wang
- Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouPeople's Republic of China
- Department of Molecular Diagnostics, Sun Yat‐Sen University Cancer CenterGuangzhouPeople's Republic of China
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Murata H, Okonogi N, Wakatsuki M, Kato S, Kiyohara H, Karasawa K, Ohno T, Nakano T, Kamada T, Shozu M, The Working Group Of Gynecological Tumors TWGOG. Long-Term Outcomes of Carbon-Ion Radiotherapy for Malignant Gynecological Melanoma. Cancers (Basel) 2019; 11:cancers11040482. [PMID: 30987391 PMCID: PMC6520847 DOI: 10.3390/cancers11040482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022] Open
Abstract
Surgical resection is considered a standard therapy for malignant melanoma (MM). However, it has not yet been established as an optimal treatment strategy for gynecological MMs, particularly owing to their very low incidence rates. We retrospectively analyzed clinical outcomes of carbon-ion radiotherapy (C-ion RT) for gynecological MMs. The eligibility criterion was the presence of histologically confirmed gynecological MM. Patients with pelvic or inguinal lymph node metastases were included, while those with distant metastases were excluded. The pelvic and inguinal lymph node regions were irradiated with up to 36 gray relative biological effectiveness (Gy (RBE)) followed by a gross tumor volume boost of up to 57.6 Gy (RBE) or 64 Gy (RBE) in 16 fractions over 4 weeks. Thirty-seven patients (median age: 71 years) were examined. In total, 22 patients had vaginal tumors, 12 had vulval tumors, and 3 had cervical uterine tumors. The median follow-up periods were 23 months (range: 5-103 months) for all patients and 53 months (range: 16-103 months) for survivors. Thirty of 37 patients (81%) achieved complete tumor disappearance. The 2-year local control, overall survival, and progression-free survival rates were 71%, 53%, and 29%, respectively. C-ion RT may be a definitive treatment option for patients with gynecological MM.
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Affiliation(s)
- Hiroto Murata
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan.
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan.
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, Tochigi 329-0498, Japan.
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Japanese Red Cross Maebashi Hospital, Maebashi 371-0811, Japan.
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Tokyo 162-8666, Japan.
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Tadashi Kamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan.
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan.
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Barcellini A, Vitolo V, Facoetti A, Fossati P, Preda L, Fiore MR, Vischioni B, Iannalfi A, Bonora M, Ronchi S, D'Ippolito E, Petrucci R, Viselner G, Ciocca M, Valvo F, Orecchia R. Feasibility of Carbon Ion Radiotherapy in the Treatment of Gynecological Melanoma. In Vivo 2019; 33:473-476. [PMID: 30804128 PMCID: PMC6506293 DOI: 10.21873/invivo.11497] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/28/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malignant melanoma of the lower genital tract is a rare disease known to have a poor prognosis. Because of the high rate of distant metastasis and unsatisfactory survival benefit, a more conservative treatment approach, instead of extensive surgery, may be warranted. Gynecological melanoma is a radioresistant tumor, an ideal disease to test the biological efficacy of carbon ion radiotherapy (CIRT). AIM To report our preliminary experience with CIRT in the treatment of gynecological melanoma at the National Center of Oncological Hadrontherapy (CNAO). PATIENTS AND METHODS Between January 2016 and February 2017, four patients were admitted for CIRT at CNAO. A case of cervical melanoma was treated with palliative aim because of large volume macroscopic disease, while three cases of vaginal melanoma were irradiated with a total dose of 68.8 Gy (relative biological effectiveness) in 16 fractions delivered over 4 weeks (4 days a week). RESULTS The age of women ranged between 49 and 72 (median=60.5 years) years. Treatment was well tolerated in all patients and all women completed the scheduled treatment course. During CIRT, toxicity was mild. For patients with vaginal disease, local control was 10.23 and 12.6 months, while that for cervical malignant melanoma was 7.3 months. All patients experienced systemic progression, with median distant metastasis-free survival of 11.7 months. The median overall survival for the whole patient group was 11.41 months. CONCLUSION In our first experiences, CIRT appears to be a safe non-invasive option for malignant melanoma of the lower genital tract, but more data and longer follow-up are necessary in order to evaluate the effectiveness and late effects.
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Affiliation(s)
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Piero Fossati
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Maria Bonora
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | | | | | - Mario Ciocca
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Roberto Orecchia
- National Center of Oncological Hadrontherapy, Pavia, Italy
- European Institute of Oncology, Milan, Italy
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Sinasac SE, Petrella TM, Rouzbahman M, Sade S, Ghazarian D, Vicus D. Melanoma of the Vulva and Vagina: Surgical Management and Outcomes Based on a Clinicopathologic Reviewof 68 Cases. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:762-771. [PMID: 30391279 DOI: 10.1016/j.jogc.2018.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study sought to evaluate the clinicopathologic features, surgical management, and survival of patients over 12 years at two academic centres. METHODS Patients diagnosed with vulvar or vaginal melanoma between 2002 and 2014 were identified through pathology databases. Clinical and pathologic data were extracted from the medical records. The Kaplan-Meier method was used to calculate recurrence-free survival and overall survival (OS), and univariate analyses using a Cox proportional hazard model were used to detect covariates related to survival. RESULTS Patients with vulvar melanoma were more likely to undergo surgical excision (84.0% vs. 55.6%, P = 0.0243) and were more likely to achieve negative margins (70.0% vs. 16.7%, P < 0.0001). Forty-eight percent of patients with vulvar melanoma had a lymph node evaluation; sentinel node biopsies were performed in 32%. Actuarial median OS for vulvar melanoma was 45 months compared with 10.48 months for vaginal melanoma. A subset of 10 patients with vulvar melanoma who survived longer than 60 months was identified. Eight significant predictors of OS were demonstrated for vulvar melanomas: clinical stage, maximum tumour size, tumour thickness, lymphovascular space invasion status, clinically enlarged lymph nodes, sentinel lymph nodes, lymph node status, and radiation treatment. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins (hazard ratio 2.60; 95% CI 1.14-5.90). CONCLUSION Surgical excision with adequate margins is the mainstay of primary management when feasible. Lymph node evaluation, including sentinel nodes, may be considered in selected patients. Vulvar and vaginal sites differ markedly with respect to pathology, initial management, and survival, and they should be evaluated separately.
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Affiliation(s)
- Sarah E Sinasac
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON.
| | - Teresa M Petrella
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Marjan Rouzbahman
- Department of Anatomical Pathology, University Health Network, Toronto, ON
| | - Shachar Sade
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Danny Ghazarian
- Department of Anatomical Pathology, University Health Network, Toronto, ON
| | - Danielle Vicus
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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30
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Inoue K, Tsubamoto H, Isono-Nakata R, Sakata K, Nakagomi N. Itraconazole treatment of primary malignant melanoma of the vagina evaluated using positron emission tomography and tissue cDNA microarray: a case report. BMC Cancer 2018; 18:630. [PMID: 29866134 PMCID: PMC5987480 DOI: 10.1186/s12885-018-4520-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/18/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the vagina is extremely rare, with a poorer prognosis than cutaneous malignant melanoma. Previous studies have explored the repurposing of itraconazole, a common oral anti-fungal agent, for the treatment of various cancers. Here, we describe a patient with metastatic, unresectable vaginal malignant melanoma treated with 200 mg oral itraconazole twice a day in a clinical window-of-opportunity trial. CASE PRESENTATION A 64-year-old Japanese woman with vaginal and inguinal tumours was referred to our institution. On the basis of an initial diagnosis of vaginal cancer metastatic to the inguinal lymph nodes, we treated her with itraconazole in a clinical trial until the biopsy and imaging study results were obtained. During this period, biopsies were performed three times, and 18F-fluoro-deoxyglucose positron emission tomography (FDG/PET)-computed tomography (CT) was performed twice. Biopsy results confirmed the diagnosis of primary malignant melanoma of the vagina. Imaging studies revealed metastases to multiple sites, including the brain, for which she underwent gamma-knife radiosurgery. During the window period before nivolumab initiation, the patient received itraconazole for 30 days. Within a week of itraconazole initiation, pain in the inguinal nodes was ameliorated. PET-CT on days 6 and 30 showed a reduction in tumour size and FDG uptake, respectively. The biopsied specimens obtained on days 1, 13, and 30 were subjected to cDNA microarray analysis, which revealed a 100-fold downregulation in the transcription of four genes: STATH, EEF1A2, TTR, and CDH2. After 12 weeks of nivolumab administration, she developed progressive disease and grade 3 immune-related hepatitis. Discontinuation of nivolumab resulted in the occurrence of left pelvic and inguinal pain. Following re-challenge with itraconazole, the patient has not reported any pain for 4 months. CONCLUSION The findings of this case suggest that itraconazole is a potential effective treatment option for primary malignant melanoma of the vagina. Moreover, we identified potential itraconazole target genes, which could help elucidate the mechanism underlying this disease and potentially aid in the development of new therapeutic agents.
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Affiliation(s)
- Kayo Inoue
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
- Department of Medical Oncology, Meiwa Hospital, Nishinomiya, Hyogo 663-8186 Japan
| | - Roze Isono-Nakata
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
| | - Kazuko Sakata
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
| | - Nami Nakagomi
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
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Cui C, Lian B, Zhou L, Song X, Zhang X, Wu D, Chi Z, Si L, Sheng X, Kong Y, Tang B, Mao L, Wang X, Li S, Dai J, Yan X, Bai X, Balch CM, Guo J. Multifactorial Analysis of Prognostic Factors and Survival Rates Among 706 Mucosal Melanoma Patients. Ann Surg Oncol 2018; 25:2184-2192. [PMID: 29748886 DOI: 10.1245/s10434-018-6503-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The hypothesis that mucosal melanomas from different anatomic sites would have different prognostic features and survival outcome was tested in a multifactorial analysis. METHODS Complete clinical and pathological information from 706 mucosal melanoma patients from different anatomical sites was compared for overall survival (OS) and prognostic factors. RESULTS Mucosal melanomas arising from different anatomical sites did not have any significant differences in OS in a multivariate analysis (p = 0.721). Among all 706 stage I-IV mucosal melanoma patients, depth of tumor invasion (p < 0.001), number of lymph node metastases (p < 0.001), and sites of distant metastases (p < 0.001) were independent prognostic factors for OS; among 543 stage I-III patients, depth of tumor invasion (p < 0.001) and number of lymph node metastases (p < 0.001) were independent prognostic factors for OS; and among 547 stage IV patients, depth of tumor invasion (p = 0.009), number of lymph node metastases (p < 0.001), and combined distant metastases and elevation of serum lactate dehydrogenase (LDH; p < 0.001) were independent prognostic factors for OS. The presence of c-KIT or BRAF mutations was not predictive of survival. CONCLUSIONS This is the first large-scale study comparing outcomes of mucosal melanomas from different anatomic sites in a multifactorial analysis. There were no significant survival differences among mucosal melanomas arising at different sites when matched for staging and prognostic and molecular factors, thus rejecting our hypothesis. We concluded that prognostic characteristics of mucosal melanomas can be staged as a single histological group, regardless of the anatomic site of the primary tumor.
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Affiliation(s)
- ChuanLiang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xin Song
- Yunnan Cancer Hospital, Kunming, China
| | - XiaoShi Zhang
- SUN YAT-SEN University Cancer Center, Guangzhou, China
| | - Di Wu
- The First Hospital of Jilin University, Changchun, China
| | - ZhiHong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - XiNan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - BiXia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - LiLi Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - SiMing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - XieQiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
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Melanoma of the lower genital tract: Prognostic factors and treatment modalities. Gynecol Oncol 2018; 150:180-189. [PMID: 29728261 DOI: 10.1016/j.ygyno.2018.04.562] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/13/2022]
Abstract
Primary melanomas originating from the gynecological tract are rare and aggressive cancers. The vulva is the most frequent site (70%), followed by vagina and more rarely by cervix. The clinical outcome of patients with female genital tract melanoma is very poor, with a 5-year overall survival (OS) of 37-50% for vulvar, 13-32% for vaginal, and approximately 10% for cervical melanoma. In this systematic review, we analyzed the pathogenesis and the different factors influencing the prognosis of melanomas of the lower genital tract, with particular emphasis on biologic variables that may influence new therapeutic approaches. We evaluated the different treatment modalities described in the literature, in order to offer a possible algorithm that may help the clinicians in diagnosing and treating patients with these uncommon malignancies.
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Abstract
OBJECTIVE The aim of the study was to evaluate the surgical management and the role of different prognostic factors on survival outcomes of women affected by genital (i.e., vulvar and vaginal) melanoma. MATERIALS AND METHODS Data of patients undergoing primary surgical treatment for genital melanoma were evaluated in this retrospective study. Baseline, pathological, and postoperative variables were tested to identify prognostic factors. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS Overall, 98 patients met the inclusion criteria. Sixty-seven (68%) and 31 (32%) patients in this study population were diagnosed with vulvar and vaginal melanoma, respectively. Median (range) DFS and OS were 12 (1-70) and 22 (1-70) months, respectively. Considering factors influencing DFS, we observed that at multivariate analysis, only vaginal localization (hazard ratio [HR] = 3.72; 95% CI = 1.05-13.2) and number of mitoses (HR = 1.24; 95% CI = 1.11-1.39) proved to be associated with worse DFS. Nodal status was the only independent factor influencing 5-year OS in patients with vulvar (HR = 1.76; 95% CI = 1.22-2.54; p = .002) and vaginal (HR = 3.65; 95% CI = 1.08-12.3; p = .03) melanoma. CONCLUSIONS Genital melanomas are characterized by a poor prognosis. Number of mitoses and lymph node status are the main factors influencing survival. Surgery is the mainstay of treatment. A correct and prompt diagnosis is paramount.
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Primary Vaginal Malignant Melanoma with Urethral Involvement Managed by Bladder Preservation. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-016-0089-6] [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]
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Tasaka R, Fukuda T, Wada T, Kawanishi M, Imai K, Kasai M, Hashiguchi Y, Ichimura T, Yasui T, Sumi T. A retrospective clinical analysis of 5 cases of vaginal melanoma. Mol Clin Oncol 2017; 6:373-376. [PMID: 28451415 DOI: 10.3892/mco.2017.1158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023] Open
Abstract
Vaginal melanoma is a rare tumor, accounting for <1% of all melanomas and ~1-5% of all vaginal malignant tumors. The prognosis of vaginal melanoma is extremely poor, as it is often resistant to chemotherapy and radiotherapy, and metastases may develop in the early stages of the disease. The present study investigated 5 patients with vaginal melanoma treated at the Department of Gynecology of Osaka City University Hospital (Osaka, Japan) between October, 2000 and April, 2014. All the cases presented with abnormal genital bleeding as the main complaint. Notably, in 3 of the 5 cases the tumors appeared as non-pigmented polyps. Local resection was performed as the primary treatment in all 5 cases. After surgery, dermal injection of interferon β (feron maintenance therapy) was performed in 3 cases, and dacarbazine, nimustine, vincristine and interferon β (DAVFeron therapy) was administered in 1 case as adjuvant therapy. All 5 cases recurred within 1 year. The site of recurrence varied, and included the vaginal wall, liver, brain and lung. The median overall survival was 419 days and the median progression-free survival 177 days. In this cohort, all the cases presented with abnormal genital bleeding as the main complaint. Therefore, malignant melanoma of the vagina must be considered along with other gynecological malignancies in patients with abnormal genital bleeding. In this study, over half of the cases had a non-pigmented polypoid lesion of the vagina. Therefore, malignant melanoma of the vagina must be considered when a polypoid lesion is identified on the vaginal wall.
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Affiliation(s)
- Reiko Tasaka
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Takeshi Fukuda
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Takuma Wada
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masaru Kawanishi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Mari Kasai
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Yasunori Hashiguchi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tomoyuki Ichimura
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tomoyo Yasui
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Toshiyuki Sumi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Hou JY, Baptiste C, Hombalegowda RB, Tergas AI, Feldman R, Jones NL, Chatterjee-Paer S, Bus-Kwolfski A, Wright JD, Burke WM. Vulvar and vaginal melanoma: A unique subclass of mucosal melanoma based on a comprehensive molecular analysis of 51 cases compared with 2253 cases of nongynecologic melanoma. Cancer 2016; 123:1333-1344. [PMID: 28026870 DOI: 10.1002/cncr.30473] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Optimal treatments for vulvar and vaginal melanomas (VVMs) have not been identified. Herein, the authors compare molecular profiles between VVM and nongynecologic melanoma (NGM) subtypes with the objective of identifying novel, targetable biomarkers. METHODS In total, 2304 samples of malignant melanoma that were submitted to Caris Life Sciences between 2009 and 2015 were reviewed. In situ hybridization and immunohistochemistry were used to assess copy numbers and protein expression of selected genes. Sequenced variants were analyzed using a proprietary cancer panel. RESULTS In total, 51 VVMs (14 vaginal and 37 vulvar melanomas) were compared with 2253 malignant NGMs, including 2127 cutaneous, 105 mucosal, and 21 acral melanomas. In VVMs, B-Raf proto-oncogene serine/threonine kinase (BRAF) was the most frequently mutated gene (26%) compared with 8.3% of mucosal NGMs (P = .008). In BRAF-mutated tumors, fewer VVMs (50%), compared with NGMs (82.1%), had a variant within the valine codon 600 (V600) domain. The KIT mutation rate was highest in VVMs (22%) compared with 3% in cutaneous (P < .001) and 8.8% in mucosal (P = .05) melanoma subtypes. NRAS mutations were rare in VVMs compared with cutaneous (25.9%; P = .009) and acral (40.6%; P = .002) melanoma subtypes. PD-L1 (56%) and PD-1 (75%) were frequently expressed in VVM, whereas PI3KCA pathway mutations and estrogen receptor/progesterone receptor expression were rare. Compared with VVMs that had KIT mutations, wild-type KIT VVMs were more likely to express molecular markers suggestive of platinum resistance (ERCC1), alkylating sensitivity (MGMT), and anthracycline sensitivity (TOP2A). CONCLUSIONS The unique molecular features of VVM render this disease a distinct subtype of melanoma. Gene-based molecular therapy and immunotherapies may be promising and should be evaluated in clinical trials. Cancer 2017;123:1333-1344. © 2016 American Cancer Society.
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Affiliation(s)
- June Y Hou
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - Caitlin Baptiste
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - Radhika Bangalore Hombalegowda
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - Ana I Tergas
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rebecca Feldman
- Medical Affairs Department, Caris Life Sciences, Phoenix, Arizona
| | - Nathaniel L Jones
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - Sudeshna Chatterjee-Paer
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - Ama Bus-Kwolfski
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - Jason D Wright
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
| | - William M Burke
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, New York
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Primary malignant melanoma of cervix and vagina. Obstet Gynecol Sci 2016; 59:415-20. [PMID: 27668208 PMCID: PMC5028652 DOI: 10.5468/ogs.2016.59.5.415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 01/27/2016] [Accepted: 03/04/2016] [Indexed: 12/22/2022] Open
Abstract
Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.
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Ferraioli D, Lamblin G, Mathevet P, Hetu J, Berakdar I, Beurrier F, Chopin N. Genital melanoma: prognosis factors and treatment modality. Arch Gynecol Obstet 2016; 294:1037-1045. [DOI: 10.1007/s00404-016-4144-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/24/2016] [Indexed: 01/11/2023]
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Kuk D, Shoushtari AN, Barker CA, Panageas KS, Munhoz RR, Momtaz P, Ariyan CE, Brady MS, Coit DG, Bogatch K, Callahan MK, Wolchok JD, Carvajal RD, Postow MA. Prognosis of Mucosal, Uveal, Acral, Nonacral Cutaneous, and Unknown Primary Melanoma From the Time of First Metastasis. Oncologist 2016; 21:848-54. [PMID: 27286787 DOI: 10.1634/theoncologist.2015-0522] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/09/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Subtypes of melanoma, such as mucosal, uveal, and acral, are believed to result in worse prognoses than nonacral cutaneous melanoma. After a diagnosis of distant metastatic disease, however, the overall survival of patients with mucosal, uveal, acral, nonacral cutaneous, and unknown primary melanoma has not been directly compared. MATERIALS AND METHODS We conducted a single-center, retrospective analysis of 3,454 patients with melanoma diagnosed with distant metastases from 2000 to 2013, identified from a prospectively maintained database. We examined melanoma subtype, date of diagnosis of distant metastases, age at diagnosis of metastasis, gender, and site of melanoma metastases. RESULTS Of the 3,454 patients (237 with mucosal, 286 with uveal, 2,292 with nonacral cutaneous, 105 with acral cutaneous, and 534 with unknown primary melanoma), 2,594 died. The median follow-up was 46.1 months. The median overall survival for those with mucosal, uveal, acral, nonacral cutaneous, and unknown primary melanoma was 9.1, 13.4, 11.4, 11.7, and 10.4 months, respectively. Patients with uveal melanoma, cutaneous melanoma (acral and nonacral), and unknown primary melanoma had similar survival, but patients with mucosal melanoma had worse survival. Patients diagnosed with metastatic melanoma in 2006-2010 and 2011-2013 had better overall survival than patients diagnosed in 2000-2005. In a multivariate model, patients with mucosal melanoma had inferior overall survival compared with patients with the other four subtypes. CONCLUSION Additional research and advocacy are needed for patients with mucosal melanoma because of their shorter overall survival in the metastatic setting. Despite distinct tumor biology, the survival was similar for those with metastatic uveal melanoma, acral, nonacral cutaneous, and unknown primary melanoma. IMPLICATIONS FOR PRACTICE Uveal, acral, and mucosal melanoma are assumed to result in a worse prognosis than nonacral cutaneous melanoma or unknown primary melanoma. No studies, however, have been conducted assessing the overall survival of patients with these melanoma subtypes starting at the time of distant metastatic disease. The present study found that patients with uveal, acral, nonacral cutaneous, and unknown primary melanoma have similar overall survival after distant metastases have been diagnosed. These findings provide information for oncologists to reconsider previously held assumptions and appropriately counsel patients. Patients with mucosal melanoma have worse overall survival and are thus a group in need of specific research and advocacy.
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Affiliation(s)
- Deborah Kuk
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander N Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rodrigo R Munhoz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Parisa Momtaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary Sue Brady
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kita Bogatch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Richard D Carvajal
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
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Schiavone MB, Broach V, Shoushtari AN, Carvajal RD, Alektiar K, Kollmeier MA, Abu-Rustum NR, Leitao MM. Combined immunotherapy and radiation for treatment of mucosal melanomas of the lower genital tract. Gynecol Oncol Rep 2016; 16:42-6. [PMID: 27331137 PMCID: PMC4899413 DOI: 10.1016/j.gore.2016.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/06/2016] [Accepted: 04/10/2016] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To report our experience using ipilimumab, a monoclonal antibody targeting CTLA-4, combined with radiation therapy in women diagnosed with mucosal melanoma of the lower genital tract. METHODS We retrospectively identified all patients who received ipilimumab with concurrent radiation treatment of mucosal melanoma of the lower genital tract at Memorial Sloan Kettering Cancer Center from 2012 to 2015. Various clinicopathologic data and treatment response were abstracted and analyzed. RESULTS Four patients were identified. Median age was 61.5 years (range 44-68); 3 were diagnosed with vaginal melanoma, 1 with cervical melanoma. All would have required extensive surgical procedures to remove entirety of disease. Median size of lesions was 4.7 cm (range, 3.3-5.3); all were Ballantyne stage I. Median number of doses of upfront ipilimumab was 4 (range, 3-4). Two patients suffered CTCAE grade 3 adverse events (colitis, rash). All received external beam radiation: 3 to 3000 cGy, 1 to 6020 cGy. Post-radiation surgical resection was performed in 3 patients (75%); 1 (33%) of 3 patients achieved complete pathologic response. Complete local radiographic response was observed in all patients after completion of initial therapy and surgery. Two developed recurrence at 9 and 10 months post-diagnosis (mediastinum, lung); 2 remain disease-free at 20 and 38 months. CONCLUSIONS Mucosal melanoma of the lower genital tract is rare, and data-driven treatment strategies limited. Immunotherapy has demonstrated durable efficacy in the treatment of cutaneous melanomas. Our small case series shows a favorable response to combined ipilimumab and radiation therapy. Larger studies are needed to validate these promising results.
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Affiliation(s)
- Maria B. Schiavone
- Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Vance Broach
- Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Alexander N. Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Richard D. Carvajal
- Experimental Therapeutics, Division of Hematology/Oncology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, USA
- Melanoma Service, Division of Hematology/Oncology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, USA
| | - Kaled Alektiar
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
- Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Marisa A. Kollmeier
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
- Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Nadeem R. Abu-Rustum
- Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Mario M. Leitao
- Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
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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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Abstract
Mucosal melanoma is an exceedingly rare variant of cutaneous melanoma that, due to its rarity, is poorly described and infrequently studied. Primary sites of origin include the head and neck, anorectum and vulvovaginal regions. It is uniquely different from cutaneous melanoma with respect to epidemiology, etiology, pathogenesis and prognosis. The etiology and pathogenesis remain unclear. Unlike cutaneous melanoma, exposure to UV light is not an apparent risk factor. Furthermore, distinct molecular features including a lower incidence of BRAF oncogene mutations but a higher incidence of KIT oncogene mutations suggest divergent genetic etiologies. Mucosal melanomas generally present at a later stage, are more aggressive and carry a worse prognosis regardless of the stage at diagnosis. Establishing standardized treatment guidelines has been challenging due to the rarity of the disease. Early detection provides the best chance at survival but is often difficult due to anatomic location. Surgery remains the primary therapeutic intervention if complete resection is technically feasible given the anatomic location. Radiotherapy may be used to achieve local control when resection is not feasible, or adjuvantly to enhance locoregional control, but most studies have failed to demonstrate an improvement in overall survival. There are no consensus guidelines on the optimal systemic therapy, and regimens are often extrapolated from data based on therapies used to treat advanced cutaneous melanoma. Clinical trials, particularly utilizing newer targeted therapies and immunotherapies, are investigating novel treatment approaches.
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Leitao MM. Management of vulvar and vaginal melanomas: current and future strategies. Am Soc Clin Oncol Educ Book 2015:e277-81. [PMID: 24857113 DOI: 10.14694/edbook_am.2014.34.e277] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Melanomas arising in the vulva and vagina are rare and therefore there is minimal data specific to these malignancies. Data are often extrapolated from other cutaneous melanomas, which may or may not be appropriate. Surgery remains the primary treatment modality at initial diagnosis and in select recurrent cases. Wide local excision of the primary lesion not requiring an exenteration, along with sentinel lymph node (SLN) mapping, should be routinely considered in vulvar melanomas. Local excision and SLN mapping is difficult and often not considered for vaginal melanomas. Primary exenterative procedures should not be routinely offered. In locally advanced cases potentially requiring an exenterative procedure, radiation therapy with or without concurrent immunotherapy is a consideration. The role of adjuvant therapy remains unclear. Surgery or radiation therapy can be considered in recurrent cases. Systemic chemotherapy agents have a modest response rate with associated poor survival outcomes. Novel immunotherapeutic and targeted agents have been reported to improve survival in melanoma and should be considered in cases of vulvovaginal melanoma. All cases should be tested for at least c-KIT and BRAF V600E mutations. Patients with vulvovaginal melanomas should be strongly encouraged to participate in clinical trials.
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Affiliation(s)
- Mario M Leitao
- From the Department of Surgery, Division of Gynecology, Memorial Sloan Kettering Cancer Center, New York, NY
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44
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Bas Esteve E, Díaz-Caneja Planell M, Peiró Marqués F. Melanoma maligno de las mucosas: melanoma vaginal a propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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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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46
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Ballester Sánchez R, de Unamuno Bustos B, Navarro Mira M, Botella Estrada R. Actualización en melanoma mucoso. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:96-103. [DOI: 10.1016/j.ad.2014.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/17/2014] [Accepted: 04/21/2014] [Indexed: 02/01/2023] Open
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47
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Ballester Sánchez R, de Unamuno Bustos B, Navarro Mira M, Botella Estrada R. Mucosal Melanoma: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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48
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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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Kollipara R, Vin H, Downing CP, Neely HK, Haws AL, Curtis SW, Tyring SK. Genital melanoma: two cases and an overview of epidemiology and treatment. J Eur Acad Dermatol Venereol 2015; 30:706-7. [PMID: 25650502 DOI: 10.1111/jdv.13002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Kollipara
- Center for Clinical Studies, Houston, TX, USA
| | - H Vin
- Baylor College of Medicine, Houston, TX, USA
| | - C P Downing
- Center for Clinical Studies, Houston, TX, USA
| | - H K Neely
- The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - A L Haws
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Pathology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S W Curtis
- Center for Clinical Studies, Houston, TX, USA
| | - S K Tyring
- Center for Clinical Studies, Houston, TX, USA.,Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Seifried S, Haydu LE, Quinn MJ, Scolyer RA, Stretch JR, Thompson JF. Melanoma of the vulva and vagina: principles of staging and their relevance to management based on a clinicopathologic analysis of 85 cases. Ann Surg Oncol 2014; 22:1959-66. [PMID: 25384702 DOI: 10.1245/s10434-014-4215-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary melanomas of the vulva and vagina are rare. As a result, it has been difficult to develop evidence-based guidelines for their management. By analyzing a large series of patients with vulval and vaginal melanomas, this study sought to document the most common presenting features, identify clinical and pathologic predictors of outcome, and provide management guidelines. METHODS A clinicopathologic analysis of 85 patients with primary melanomas of the vulva or vagina diagnosed and treated at Melanoma Institute Australia and associated units in Sydney, Australia, between 1960 and 2011 was performed. Predictors of disease-free and melanoma-specific survival (MSS) were determined. RESULTS Patients with American Joint Committee on Cancer (AJCC) stage 0-II had a significantly better MSS (5Y MSS = 63.6 %, n = 59) compared with those with stage III disease (5Y MSS = 0 %, n = 12, p < 0.001). Tumor thickness, ulceration status, and pathologic clearance margin were significant predictors of MSS. Disease-free survival was predicted by these factors and additionally by tumor mitotic rate. CONCLUSIONS The results of this study provide evidence to support the appropriateness of utilizing the AJCC (7th edition) cutaneous melanoma staging system for vulval and vaginal melanomas. Detection and removal of these melanomas at an early stage with pathologically confirmed clear margins confers the best chance of cure.
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Affiliation(s)
- Susan Seifried
- Melanoma Institute Australia (formerly the Sydney Melanoma Unit), North Sydney, NSW, Australia
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