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Maffei E, D'Antonio A, Addesso M, Pandolfo SD, Verze P, Caputo A. Exploring the landscape of urinary tract melanomas: A review for pathologists and clinicians. Urologia 2024:3915603241263215. [PMID: 39045672 DOI: 10.1177/03915603241263215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Melanomas originating within the urinary tract represent a rare and clinically challenging subset of malignancies. Despite extensive research on cutaneous melanomas, urinary tract melanomas remain relatively unexplored, presenting diagnostic dilemmas and limited treatment consensus. In this comprehensive review, we synthesize current knowledge on the epidemiology, risk factors, clinical presentation, histopathological characteristics, and treatment strategies specific to this disease. Enhancing clinical awareness, refining diagnostic approaches, and exploring novel therapeutic interventions hold promise for improving outcomes in this challenging malignancy subset.
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Affiliation(s)
| | | | - Maria Addesso
- Department of Pathology, PO Tortora, Pagani (SA), Italy
| | | | - Paolo Verze
- Department of Urology, University Hospital of Salerno, Italy
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2
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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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3
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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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4
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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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5
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Vaginal melanoma in Denmark from 1980 to 2018: A population-based study based on genetic profile and survival. Gynecol Oncol 2022; 165:53-59. [DOI: 10.1016/j.ygyno.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022]
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6
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Albuquerque KS, Zoghbi KK, Gomes NBN, Libânio BB, Souza e Silva TX, de Araújo EM, Lewin F, Pedroso MHNI, Torres US, D'Ippolito G, Racy DJ, Bernardo GCO. Vaginal cancer: Why should we care? Anatomy, staging and in-depth imaging-based review of vaginal malignancies focusing on MRI and PET/CT. Clin Imaging 2022; 84:65-78. [DOI: 10.1016/j.clinimag.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 11/03/2022]
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7
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Lewin J, Egbe A, Ellery P, Wilkinson N, MacDonald N, Kotsopoulos IC, Olaitan A. Female Genital Tract Melanoma: 10 Years of Experience at a Single Tertiary Center. J Low Genit Tract Dis 2021; 25:142-145. [PMID: 33587530 DOI: 10.1097/lgt.0000000000000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade. METHODS Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist. RESULTS We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026). CONCLUSIONS Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
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Affiliation(s)
- Jonathan Lewin
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Azelle Egbe
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Peter Ellery
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Nafisa Wilkinson
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Nicola MacDonald
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Ioannis C Kotsopoulos
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Adeola Olaitan
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
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8
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Imaging Studies in a Primary Vaginal Melanoma Disguised as a Suburethral Cyst: A Case Report. Female Pelvic Med Reconstr Surg 2021; 27:e252-e255. [PMID: 33208656 DOI: 10.1097/spv.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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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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10
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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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11
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Pumpure E, Dručka E, Kigitoviča D, Meškauskas R, Isajevs S, Nemiro I, Rasa A, Olmane E, Zablocka T, Alberts P, Doniņa S. Management of a primary malignant melanoma of uterine cervix stage IVA patient with radical surgery and adjuvant oncolytic virus Rigvir ® therapy: A case report. Clin Case Rep 2020; 8:1538-1543. [PMID: 32884791 PMCID: PMC7455402 DOI: 10.1002/ccr3.2928] [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: 01/29/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 02/03/2023] Open
Abstract
Primary malignant melanoma of the uterine cervix is a rare disease with poor prognosis and high recurrence rate. We used Rigvir® as adjuvant therapy for a stage IVA patient. Tolerability, overall and progression-free survival are good.
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Affiliation(s)
- Elizabete Pumpure
- Department of Obstetrics and GynaecologyRiga Stradiņš UniversityRigaLatvia
- Riga Maternity HospitalRigaLatvia
| | - Eva Dručka
- Department of Internal DiseasesRiga Stradiņš UniversityRigaLatvia
| | - Dana Kigitoviča
- Department of Internal DiseasesRiga Stradiņš UniversityRigaLatvia
| | - Raimundas Meškauskas
- National Center of PathologyAffiliate of Vilnius University Hospital Santaros KlinikosVilniusLithuania
| | - Sergejs Isajevs
- Centre of PathologyRiga Eastern Clinical University HospitalRigaLatvia
- Department of PathologyFaculty of MedicineUniversity of LatviaRigaLatvia
| | - Ineta Nemiro
- Department of Diagnostic RadiologyOncology Centre of LatviaRigaLatvia
| | | | - Evija Olmane
- Department of RadiologyPauls Stradiņš Clinical University HospitalRigaLatvia
| | - Tatjana Zablocka
- Centre of PathologyRiga Eastern Clinical University HospitalRigaLatvia
- Department of PathologyFaculty of MedicineUniversity of LatviaRigaLatvia
| | | | - Simona Doniņa
- Oncology Centre of LatviaRiga East University HospitalRigaLatvia
- Institute of Microbiology and VirologyRiga Stradiņš UniversityRigaLatvia
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12
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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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13
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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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14
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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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15
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Female genitourinary tract melanoma: mutation analysis with clinicopathologic correlation: a single-institution experience. Melanoma Res 2019; 28:586-591. [PMID: 30028779 DOI: 10.1097/cmr.0000000000000480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Female genitourinary tract melanoma (FGTM) is a rare and often-fatal form of mucosal melanoma. We describe our institutional experience with 55 cases of FGTM, 16 of which were evaluated with next-generation sequencing targeting 151 cancer-associated genes. Tumors tended to be thicker than conventional melanoma at presentation (median: 3.2 mm), were frequently ulcerated (50%), and characterized by incomplete initial resections. Regional lymph nodes showed tumor involvement at presentation in 28% of cases. With a median follow-up of 23.6 months, the median recurrence free survival was 14.5 months and the median overall survival was 29.6 months. Genomic analysis revealed mutually exclusive mutations in TP53 and KIT in 25%, while 19% of cases showed BRAF mutation. NRAS mutation was found in 13% of cases. Mutation in ATRX, previously undescribed in mucosal melanoma, was seen in three (10%) of 16 patients. Only invasive melanoma cases were included in statistical analyses. Patients with three or more mutations had marginally worse overall survival rates than those with two or less (P=0.07). Further studies are required for potential adjuvant treatment modalities to improve survival outcomes of FGTM.
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Boer FL, Ten Eikelder MLG, Kapiteijn EH, Creutzberg CL, Galaal K, van Poelgeest MIE. Vulvar malignant melanoma: Pathogenesis, clinical behaviour and management: Review of the literature. Cancer Treat Rev 2018; 73:91-103. [PMID: 30685613 DOI: 10.1016/j.ctrv.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/16/2023]
Abstract
Vulvar malignant melanoma (VMM) is a rare disease, accounting for 5% of all vulvar malignancies and is characterized by low survival and high recurrence rates. It is considered as a distinct entity of mucosal melanoma. Prognostic factors are higher age, advanced Breslow thickness, and lymph node involvement whilst central localization and ulceration status are still under debate. Surgery is the cornerstone for the treatment of primary VMM, however, it can be mutilating due to the anatomical location of the disease. Elective lymph node dissection is not part of standard care. The value of sentinel lymph node biopsy in VMM is still being studied. Radiation therapy and chemotherapy as adjuvant treatment do not benefit survival. Immunotherapy in cutaneous melanoma has shown promising results but clinical studies in VMM are scarce. In metastatic VMM, checkpoint inhibitors and in case of BRAF or KIT mutated metastatic VMM targeted therapy have shown clinical efficacy. In this review, we present an overview of clinical aspects, clinicopathological characteristics and its prognostic value and the latest view on (adjuvant) therapy and follow-up.
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Affiliation(s)
- Florine L Boer
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ellen H Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Khadra Galaal
- Department of Gynaecology, Royal Cornwall Hospital NHS Trust, United Kingdom
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Pankaj S, Kumari A, Kumari A, Choudhary V, Kumari J, Nazneen S. Primary Malignant Melanoma of the Female Genital Tract: A Series of Interesting Cases. J Obstet Gynaecol India 2018; 69:80-83. [PMID: 30956500 DOI: 10.1007/s13224-018-1169-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/12/2018] [Indexed: 02/03/2023] Open
Affiliation(s)
- Sangeeta Pankaj
- 1Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014 India
| | - Anita Kumari
- 1Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014 India
| | - Anjili Kumari
- 1Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014 India
| | | | - Jaya Kumari
- 1Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014 India
| | - Syed Nazneen
- 1Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014 India
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Pankaj S, Kumari A, Kumari J, Nazneen S, Kumari A, Choudhary V. Cervical Melanoma, a Rare Tumor with Poor Prognosis: Case Report and Review of Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0216-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Saito T, Tabata T, Ikushima H, Yanai H, Tashiro H, Niikura H, Minaguchi T, Muramatsu T, Baba T, Yamagami W, Ariyoshi K, Ushijima K, Mikami M, Nagase S, Kaneuchi M, Yaegashi N, Udagawa Y, Katabuchi H. Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of vulvar cancer and vaginal cancer. Int J Clin Oncol 2018; 23:201-234. [PMID: 29159773 PMCID: PMC5882649 DOI: 10.1007/s10147-017-1193-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vulvar cancer and vaginal cancer are relatively rare tumors, and there had been no established treatment principles or guidelines to treat these rare tumors in Japan. The first version of the Japan Society of Gynecologic Oncology (JSGO) guidelines for the treatment of vulvar cancer and vaginal cancer was published in 2015 in Japanese. OBJECTIVE The JSGO committee decided to publish the English version of the JSGO guidelines worldwide, and hope it will be a useful guide to physicians in a similar situation as in Japan. METHODS The guideline was created according to the basic principles in creating the guidelines of JSGO. RESULTS The guidelines consist of five chapters and five algorithms. Prior to the first chapter, basic items are described including staging classification and history, classification of histology, and definition of the methods of surgery, radiation, and chemotherapy to give the reader a better understanding of the contents of the guidelines for these rare tumors. The first chapter gives an overview of the guidelines, including the basic policy of the guidelines. The second chapter discusses vulvar cancer, the third chapter discusses vaginal cancer, and the fourth chapter discusses vulvar Paget's disease and malignant melanoma. Each chapter includes clinical questions, recommendations, backgrounds, objectives, explanations, and references. The fifth chapter provides supplemental data for the drugs that are mentioned in the explanation of clinical questions. CONCLUSION Overall, the objective of these guidelines is to clearly delineate the standard of care for vulvar and vaginal cancer with the goal of ensuring a high standard of care for all women diagnosed with these rare diseases.
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Affiliation(s)
- Toshiaki Saito
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University, Tokushima, Japan
| | - Hiroyuki Yanai
- Department of Diagnostic Pathology, Okayama University Hospital, Okayama, Japan
| | - Hironori Tashiro
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hitoshi Niikura
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Minaguchi
- Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Toshinari Muramatsu
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsukasa Baba
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuya Ariyoshi
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masanori Kaneuchi
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Udagawa
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
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Kalampokas E, Kalampokas T, Damaskos C. Primary Vaginal Melanoma, A Rare and Aggressive Entity. A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2017; 31:133-139. [PMID: 28064232 DOI: 10.21873/invivo.11036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/26/2016] [Accepted: 11/12/2016] [Indexed: 01/21/2023]
Abstract
Malignant melanoma of the vagina is a rare, aggressive malignancy of poor prognosis. It principally affects post-menopausal women, with a mean age of 57 years, and the factors that contribute to its appearance are not well known. The first case of primary malignant vaginal melanoma was reported in 1887 and modern literature has noted about 500 cases, globally. Vaginal melanomas constitute 0.3% of all malignant melanomas and fewer than 3% of all vaginal carcinomas. To date there is no clear consensus regarding treatment. An early, accurate diagnosis and prompt investigation is essential in reaching appropriate treatment decisions. We present a clinical case of primary vaginal melanoma and review the literature briefly, presenting the current treatment plans and updates of this rare gynecological malignancy. Considerations, epidemiology, associated risk factors, response to therapy and expected outcome are also discussed. CONCLUSION Primary malignant vaginal melanoma is a rare but aggressive melanoma that affects women in their 6th and 7th decade of life. The tumor appears as a dark node or spindle but can also be amelanotic. The size of the tumor is indicative of the prognostic factors. Surgery seems to be the only efficient treatment. Postoperative adjuvant therapy might help in preventing recurrence of the tumor. The survival rate is largely dependent on nodal and distant metastasis of the disease after initial tumor resection. There is a dire need to form a proper therapeutic regime to control this disease.
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Affiliation(s)
| | - Theodoros Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens Medical School, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece .,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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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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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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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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Vyas R, Thompson CL, Zargar H, Selph J, Gerstenblith MR. Epidemiology of genitourinary melanoma in the United States: 1992 through 2012. J Am Acad Dermatol 2016; 75:144-50. [DOI: 10.1016/j.jaad.2015.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/07/2015] [Accepted: 10/17/2015] [Indexed: 10/21/2022]
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Abstract
Radical surgery is considered not to improve the prognosis of primary malignant melanoma of the vagina (PMMV). This study was carried out to review the general consensus. A systematic review was performed on the basis of data from 10 patients in our cohort and 147 patients in the previous literature. The radicality of the initial surgery (RAINS) score was defined as the total number of points in terms of the resected organs. The target organs were the vagina, vulva, urethra, bladder, uterus, anus, rectum, pelvic lymph nodes, and inguinal lymph nodes. Overall survival (OS) according to the RAINS score was analyzed using the Kaplan-Meier method. Information on tumor stage, size, and depth of invasion was not obtained in 15, 47, and 43% of patients, respectively. The median follow-up period was 18 months. OS with a RAINS score of at least 7 was significantly longer than that with a RAINS score of up to 6 (median survival time, 41 vs. 19 months; log-rank test, P=0.037), despite the fact that the former group included significantly more patients with advanced-stage disease. A significant difference in OS was not found between patients with a RAINS score of at least 6 and up to 5. The therapeutic significance of radical surgery for PMMV has not been assessed appropriately in previous studies because of the lack of comparability among groups and differences in the definitions of surgical radicality. Patients with PMMV might benefit from initial surgery with appropriate surgical radicality, despite incomplete validation of the RAINS score.
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Abstract
PURPOSE OF REVIEW Primary melanomas originating from the gynaecological tract are rare and aggressive cancers. The 5-year survival is around 10%. The majority of tumours differ from cutaneous melanomas, which arise from the skin, by developing from melanocytes located in mucosal epithelium. The clinical behaviour, prognosis and the biology of mucosal melanomas are distinct from cutaneous melanomas. In this article, we summarize the current management of melanomas of the gynaecological tract (vulva, vagina, ovary and cervix) and discuss the progress in developing new treatments. RECENT FINDINGS The management of mucosal melanomas has not changed substantially over the last decade and the prognosis remains poor. Surgery remains the primary treatment of choice in all localized melanomas of the genital tract. Radiotherapy and chemotherapy are options but have limited success for the majority of women. Activation of c-KIT occurs in vulvar melanomas. Clinical trials of targeted agents are underway. SUMMARY As a result of the rarity of gynaecological tract melanomas, challenges associated with their anatomical locations and resistance to conventional radiotherapy and chemotherapy, this group of conditions remain difficult to treat and continue to have a poor prognosis. A greater understanding of the molecular profile of these cancers may provide promising targeted approaches.
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Liu QY, Zeng YP, Lin XF, Liu ZF, Wu XF, Li HG. MRI findings in primary vaginal melanoma-a report of four cases. Clin Imaging 2014; 39:533-7. [PMID: 25560672 DOI: 10.1016/j.clinimag.2014.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/15/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
Primary vaginal melanoma is a rare malignant tumor. We review the clinical presentation and magnetic resonance imaging (MRI) appearances of this entity in four patients. The MRI findings in vaginal melanoma are various and may be confused with other malignant vaginal tumor. Pelvic MRI is helpful for accurate preoperative staging of vaginal melanoma.
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Affiliation(s)
- Qing-Yu Liu
- Department of Radiology, Zengcheng People's Hospital, 1 Guang Ming Dong Road, Zengcheng 511300, Guangdong Province, China; Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Xi Road, Guangzhou 510120, Guangdong Province, China.
| | - Yu-Ping Zeng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Xi Road, Guangzhou 510120, Guangdong Province, China
| | - Xiao-Feng Lin
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Xi Road, Guangzhou 510120, Guangdong Province, China
| | - Zhi-Feng Liu
- Department of Radiology, Zengcheng People's Hospital, 1 Guang Ming Dong Road, Zengcheng 511300, Guangdong Province, China
| | - Xiao-Feng Wu
- Department of Radiology, Zengcheng People's Hospital, 1 Guang Ming Dong Road, Zengcheng 511300, Guangdong Province, China
| | - Hai-Gang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
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