1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
McGowan M, O'Carrigan B, Martins FC, Haldar K, Pathiraja P. Organ-sparing central pelvic compartment resection for the treatment of vulvo-vaginal melanomas. Melanoma Manag 2023; 10:MMT66. [PMID: 38229953 PMCID: PMC10789441 DOI: 10.2217/mmt-2023-0001] [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] [Received: 06/02/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
Vulvo-vaginal melanomas are one of the rarest gynecological oncology diseases with a poor survival compared with other malignancies. The 5-year survival varies from 13% to 32.3%. Vulvo-vaginal melanomas involving the upper 2/3rds of the vagina are usually treated with total pelvic exenteration (TPE). TPE surgery carries a 50% risk of major complications and also morbidity associated with double stomas. Central pelvic compartment resection is a novel organ-sparing surgical approach entailing radical total laparoscopic hysterectomy, bilateral salpingo-oophrectomy, laparoscopic vaginectomy and vulvectomy to reduce morbidity compared with TPE. Permanent suprapubic catheters are used if there is urethral involvement but require quality of life studies to assess their long-term outcomes.
Collapse
Affiliation(s)
- Mark McGowan
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| | - Brent O'Carrigan
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| | | | - Krishnayan Haldar
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| | - Pubudu Pathiraja
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Trétarre B, Dantony E, Coureau G, Defossez G, Guizard AV, Delafosse P, Daubisse L, Velten M, Karima Hammas, Barra S, Lapotre B, Plouvier S, d'Almeida T, Molinié F, Woronoff AS. Trends in incidence of invasive vaginal cancer in France from 1990 to 2018 and survival of recently diagnosed women - A population-based study. Eur J Obstet Gynecol Reprod Biol 2023; 283:125-129. [PMID: 36842246 DOI: 10.1016/j.ejogrb.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The aim of this study was to analyze trends in the incidence of vaginal cancer in France over a 28-year period and to present survival for recently-diagnosed women. METHODS French cancer registries provided data on invasive vaginal cancers diagnosed from 1990 to 2015 and followed up through June 2018. Trends in incidence were analyzed using a Poisson model with a bidimensional penalized spline of age and year at diagnosis. Net survival analysis was restricted to recently-diagnosed cases (2010-2015) and used a novel approach based on a bidimensional penalized spline of age and time-since-diagnosis to model excess mortality hazard. RESULTS With 162 new cases estimated in France in 2018, vaginal cancer represented 0.9 % of genital cancers in French women. In 2018, the world population age-standardized incidence rate was 0.2 per 100,000 person-years, median age at diagnosis was 75 years. The standardized incidence rate decreased significantly by 3 % per year (95 % CI, -3.8; -2.2) between 1990 and 2018 (0.4 cases per 100,000 person-year in 1990, vs 0.2 in 2018). Age-standardized net survival at 1 and 5 years after diagnosis was respectively 74 % and 45 %. CONCLUSIONS This study confirms that vaginal cancer is still a rare malignancy in France with 5-year net survival that remains low. We observed a consistent decrease in the incidence rate between 1990 and 2018. It may be too early to attribute these trends to a positive impact of vaccination campaigns against hrHPV infection, since vaginal cancer mainly affects older women and HPV vaccination has only been available since the early 2000s, and only targets young girls.
Collapse
Affiliation(s)
- Brigitte Trétarre
- Registre des Tumeurs de l'Hérault, 208 rue des Apothicaires, Montpellier, France; CERPOP INSERM U1295, Toulouse III University, F-31000, France; FRANCIM Network, Toulouse F-31073, France.
| | - Emmanuelle Dantony
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Gaëlle Coureau
- FRANCIM Network, Toulouse F-31073, France; Epicene, Centre Inserm U1219/CHU de Bordeaux, Service d'information Médicale, Université Bordeaux, Bordeaux, France
| | - Gautier Defossez
- FRANCIM Network, Toulouse F-31073, France; Registre général des cancers de Poitou-Charentes, Pôle Biologie, Pharmacie et Santé Publique, CHU de Poitiers, Poitiers, France; Université de Poitiers, Poitiers, France; INSERM Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Anne-Valérie Guizard
- FRANCIM Network, Toulouse F-31073, France; Registre Général des Tumeurs du Calvados, Caen, France
| | - Patricia Delafosse
- FRANCIM Network, Toulouse F-31073, France; Registre Général des Cancers de l'Isère, Meylan, France
| | - Laetitia Daubisse
- CERPOP INSERM U1295, Toulouse III University, F-31000, France; FRANCIM Network, Toulouse F-31073, France; Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, Toulouse, F-31059, France
| | - Michel Velten
- FRANCIM Network, Toulouse F-31073, France; Registre des Cancers du Haut-Rhin, Mulhouse, France
| | - Karima Hammas
- FRANCIM Network, Toulouse F-31073, France; Registre des Cancers du Haut-Rhin, ARER68, Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace (GHRMSA), Mulhouse, France
| | - Simona Barra
- FRANCIM Network, Toulouse F-31073, France; Registre des Cancers de la Manche, Cherbourg-Octeville, France
| | - Bénédicte Lapotre
- FRANCIM Network, Toulouse F-31073, France; Registre du cancer de la Somme, hôpital nord CHU Amiens-Picardie, Amiens, France
| | - Sandrine Plouvier
- FRANCIM Network, Toulouse F-31073, France; Registre général des cancers de Lille et de sa région, Lille, France
| | - Tania d'Almeida
- FRANCIM Network, Toulouse F-31073, France; Registre général des cancers de la Haute-Vienne - CHU de Limoges, Limoges, France
| | - Florence Molinié
- CERPOP INSERM U1295, Toulouse III University, F-31000, France; FRANCIM Network, Toulouse F-31073, France; Registre des Cancers de Loire-Atlantique et Vendee, CHU de Nantes, France
| | - Anne-Sophie Woronoff
- FRANCIM Network, Toulouse F-31073, France; Doubs Cancer Registry, Besançon University Hospital, Besançon, France; Research Unit EA3181, Franche-Comté University, Besançon, France
| |
Collapse
|
5
|
Gao C, Li H, Wu R, Chen W. Prognostic nomogram and treatment efficacy analysis for vaginal cancer: A SEER database and external validation study. Int J Gynaecol Obstet 2023. [PMID: 36947104 DOI: 10.1002/ijgo.14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To analyze the prognosis and treatment decisions for patients with vaginal cancer through a large retrospective cohort study, in order to assist clinicians to evaluate the condition and choose treatment methods. METHODS This was a retrospective study analyzed with Cox regression, nomogram, and external validation. The Kaplan-Meier curve was used for comparative analysis of various treatment modalities. RESULTS A total of 6650 cases of vaginal cancer diagnosed between 2000 and 2018 from the Surveillance, Epidemiology, and End Results database and 106 cases diagnosed between 2006 and 2021 from Fujian Cancer Hospital were identified. Young age, early FIGO (the International Federation of Gynecology and Obstetrics) stage, well-differentiated, squamous and adenocarcinoma, first primary malignancy, married, undergoing surgery, and chemoradiotherapy were good independent prognostic factors (P < 0.001). The internal and external validation concordance indices were 0.7102 and 0.7785, respectively. The Kaplan-Meier curves indicated that surgery, radiotherapy, and chemotherapy significantly improved survival in patients with vaginal cancer. Forest plots suggest that radiotherapy combined with surgery was superior to radiotherapy alone (P < 0.001). CONCLUSION We established a specific nomogram to predict vaginal cancer prognosis. Surgery combined with external beam radiation plus brachytherapy may be the most recommended treatment option.
Collapse
Affiliation(s)
- Chen Gao
- Department of Obstetrics and Gynecology, Ningde Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Hui Li
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Rongrong Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Wenjuan Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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]
|
8
|
Matsuo K, Nishio S, Ogata D, Kato T, Matsuura M, Mikami M, Enomoto T. Treatment specialty-specific characteristics and outcomes in women with vulvo-vaginal melanoma: A JGOG-JSCS joint study. J Surg Oncol 2022; 125:1333-1337. [PMID: 35239200 DOI: 10.1002/jso.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Dai Ogata
- Department of Dermatology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan
| |
Collapse
|
9
|
Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
Collapse
Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
| |
Collapse
|
10
|
Carbó-Bagué A, Rubió-Casadevall J, Puigdemont M, Sanvisens A, Oliveras G, Coll M, del Olmo B, Perez-Bueno F, Marcos-Gragera R. Epidemiology and Molecular Profile of Mucosal Melanoma: A Population-Based Study in Southern Europe. Cancers (Basel) 2022; 14:cancers14030780. [PMID: 35159047 PMCID: PMC8833680 DOI: 10.3390/cancers14030780] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/04/2022] [Accepted: 01/30/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary There are few population-based studies focused on the epidemiology of mucosal melanoma, a rare neoplasm. Its poor prognosis, the different etiology from cutaneous melanoma and the lack of effective treatment beyond corrective surgery, make the knowledge of the mutational profile of this type of cancer a useful tool in understanding its natural history and also for the investigation of new target therapies. The aim of our population-based study is to analyze the incidence and survival of mucosal melanoma, which mainly arises from the head and neck sphere, genitourinary tract and rectal area, and to carry out the mutational analysis of selected cases. We used the Girona Cancer Registry database, which registered all cancer cases in Girona, a province of Spain in southern Europe, during the period of 1994–2018. Abstract Background: Mucosal melanoma is a rare neoplasm on which few epidemiological population-based studies have been published. A good surgical approach is the standard treatment, but the prognosis is worse than that of skin melanoma. The analysis of mucosal melanoma’s mutational profile can help to develop target therapies in advanced disease or adjuvant settings. Methods: We analyzed the database of the Cancer Registry of Girona, a region located in the north-east of Spain, in the period of 1994–2018. We selected cases of primary invasive melanoma, excluding those located in the skin, eye, central nervous system and an unknown primary site. Epidemiological analysis included incidence and survival. Mutational profile analysis was performed with a custom gene panel. Results: Forty-two patients were identified: 14 (33%) had vulvar-vaginal melanoma, 15 (35.7%) had rectal melanoma, 12 (28.6%) had melanoma located in the head and neck sphere and 1 male patient had a urethral melanoma. European age-standardized incidence rates for vulvar-vaginal, rectal and head and neck melanoma were 0.09, 0.1 and 0.09 cases/100,000 inhabitant-years, respectively. Five-year observed survival rates were 37.5%, 20% and 25% for these types of cancers. NRAS Q61 was the most frequent mutation found. Conclusion: Our study confirms the steady incidence and low survival of mucosal melanomas in a region of southern Europe. NRAS and NF1 play a role in the molecular landscape of mucosal melanoma. MEK and PI3K/mTOR inhibitors could be reasonable treatment options and are being studied in clinical trials.
Collapse
Affiliation(s)
- Anna Carbó-Bagué
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Universitari Josep Trueta, Av. França S/N, 17007 Girona, Spain;
- Research Group on Descriptive Epidemiology, Genetics and Cancer Prevention, Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (A.S.); (R.M.-G.)
- Correspondence: ; Tel.: +34-972-225834
| | - Jordi Rubió-Casadevall
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Universitari Josep Trueta, Av. França S/N, 17007 Girona, Spain;
- Research Group on Descriptive Epidemiology, Genetics and Cancer Prevention, Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (A.S.); (R.M.-G.)
- School of Medicine, University of Girona (UdG), 17003 Girona, Spain;
| | - Montserrat Puigdemont
- Research Group on Descriptive Epidemiology, Genetics and Cancer Prevention, Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (A.S.); (R.M.-G.)
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, 17004 Girona, Spain
| | - Arantza Sanvisens
- Research Group on Descriptive Epidemiology, Genetics and Cancer Prevention, Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (A.S.); (R.M.-G.)
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, 17004 Girona, Spain
| | - Glòria Oliveras
- Pathology Department, Hospital Josep Trueta, Catalan Institute of Health, 17007 Girona, Spain; (G.O.); (F.P.-B.)
| | - Mònica Coll
- Cardiovascular Genetics Center, Biomedical Research Institute of Girona (IDIBGI), 17190 Salt, Spain;
| | - Bernat del Olmo
- School of Medicine, University of Girona (UdG), 17003 Girona, Spain;
- Cardiovascular Genetics Center, Biomedical Research Institute of Girona (IDIBGI), 17190 Salt, Spain;
| | - Ferran Perez-Bueno
- Pathology Department, Hospital Josep Trueta, Catalan Institute of Health, 17007 Girona, Spain; (G.O.); (F.P.-B.)
| | - Rafael Marcos-Gragera
- Research Group on Descriptive Epidemiology, Genetics and Cancer Prevention, Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (A.S.); (R.M.-G.)
- School of Medicine, University of Girona (UdG), 17003 Girona, Spain;
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, 17004 Girona, Spain
| |
Collapse
|
11
|
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]
|
12
|
Abstract
Diagnosis of a primary vaginal cancer is rare, as most vaginal tumors are metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This is associated with persistence of high‐risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, as with cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer. A review of the different histologic subtypes of primary vaginal cancer in terms of staging and role of imaging, as well as treatment options and prognoses.
Collapse
Affiliation(s)
- Tracey S Adams
- Department of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC), Cape Town, South Africa.,University of Cape Town Global Surgery, Cape Town, South Africa
| | - Linda J Rogers
- Department of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC), Cape Town, South Africa
| | - Mauricio A Cuello
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
13
|
Abstract
Noncutaneous melanomas are rare subtypes of melanoma with high rates of metastatic disease and poor overall survival. One-third to one-half of cases are amelanotic, which may contribute to a delay in diagnosis. Immunohistochemistry staining with typical melanoma markers helps confirm the diagnosis. There is no standard staging system across mucosal melanomas. Elective nodal dissection is not recommended and there is a paucity of data to support use of sentinel lymph node biopsy. Mutational analysis should be routinely performed. Systemic therapy options include targeted inhibitors, immunotherapy, and cytotoxic chemotherapy, although further studies are needed to confirm their efficacy.
Collapse
Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA.
| | - Russell S Berman
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA. https://twitter.com/bermar01
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
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]
|
17
|
Seow DYB, Busmanis I. Persistent vaginal melanoma as an unusual mimic in the endocervix. Pathology 2020; 53:552-555. [PMID: 33261829 DOI: 10.1016/j.pathol.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Dominique Y B Seow
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore.
| | - Inny Busmanis
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore
| |
Collapse
|
18
|
Bi Y, Yi M, Yu Z, Han X, Ren J. Clinical outcomes of transarterial chemotherapy and embolization for vaginal cancer. J Obstet Gynaecol Res 2020; 46:924-930. [PMID: 32144875 DOI: 10.1111/jog.14234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
AIM We report clinical outcomes of transarterial embolization in 19 cases of vaginal cancer. METHODS From August 2011 to October 2019, 19 patients with histologically diagnosed vaginal cancer were identified in our department. Transarterial chemotherapy and embolization was performed for all patients. Patient characteristics, treatment plans and the clinical outcomes, were recorded. RESULTS Among 19 identified cases, nine of them are squamous cell carcinoma, five of adenocarcinoma, one of adenosquamous carcinoma, two of vaginal malignant melanoma, one leiomyosarcoma and one of stromal sarcoma. Transarterial chemotherapy and embolization was successfully performed in all patients. No related complication was found after intervention treatment. Besides, eight patients received adjuvant chemotherapy, four received both adjuvant chemotherapy and radiotherapy and seven received no therapies. Four patients were cured and seven were stable during follow-up. CONCLUSION Transarterial embolization appears safe and effective for vaginal cancer, with a currently acceptable prognosis.
Collapse
Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengfei Yi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zepeng Yu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Hahn HM, Lee KG, Choi W, Cheong SH, Myung KB, Hahn HJ. An updated review of mucosal melanoma: Survival meta-analysis. Mol Clin Oncol 2019; 11:116-126. [PMID: 31281645 PMCID: PMC6589937 DOI: 10.3892/mco.2019.1870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/10/2019] [Indexed: 12/12/2022] Open
Abstract
Mucosal melanoma (MM) is a highly lethal variant of melanoma that carries a poor prognosis. Extremely low incidence and survival rates have led to few clinical trials, and a lack of protocols and guidelines. The present study performed a survival meta-analysis for the quantitative synthesis of available evidence to search for key patterns that would help clinicians tailor optimal therapeutic strategies in MM. PubMed, EMBASE, Cochrane, MEDLINE, Google Scholar and other databases were searched. Hazard ratios, in disease-specific and overall survival, were calculated for each of the survival-determining variables. MM was 2.25 times more lethal than cutaneous melanoma (CM). The most significant threats to survival were advanced Tumor-Node-Metastasis stage, sino-nasal location, and old age. Chemotherapy was the most effective form of adjuvant therapy. Disease-specific survival, the primary measure of the effect sizes, can fluctuate depending on the accuracy of the reported cause of mortality. In conclusion, MM is a peculiar type of melanoma, with clinical and molecular profile vastly different from the much-familiar CM. In the wake of the era of precision oncology, further studies on driver mutations and oncogenic pathways would likely lead to improved patient survival.
Collapse
Affiliation(s)
- Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Gyeonggi 16499, Republic of Korea
| | - Kyoung Geun Lee
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Won Choi
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Seung Hyun Cheong
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Ki Bum Myung
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Hyung Jin Hahn
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea.,Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| |
Collapse
|
21
|
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.
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Abstract
Diagnosis of a primary vaginal cancer is rare because most of these lesions will be metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This will be associated with persistence of high-risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, similar to cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer.
Collapse
Affiliation(s)
- Tracey S Adams
- Department of Gynecological Oncology, Groote Schuur Hospital/University of Cape Town, Cape Town, South Africa.,South African Medical Research Council/University of Cape Town Gynaecological Cancer Research Centre (SA MRC/UCT GCRC), Cape Town, South Africa
| | - Mauricio A Cuello
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
24
|
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.
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
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.
Collapse
|
27
|
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]
|
28
|
Affiliation(s)
- Neville F Hacker
- Gynecologic Oncology Cancer Centre, Royal Hospital for Women, Randwick, Australia
| | - Patricia J Eifel
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX, USA
| | | |
Collapse
|
29
|
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.
Collapse
|
30
|
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.
Collapse
|
31
|
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.
Collapse
|
32
|
Gadducci A, Fabrini MG, Lanfredini N, Sergiampietri C. Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors. Crit Rev Oncol Hematol 2015; 93:211-24. [DOI: 10.1016/j.critrevonc.2014.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/26/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022] Open
|
33
|
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.
Collapse
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
| |
Collapse
|