Review

Clinical characteristics and current treatment approach of vaginal primary malignant melanoma

Georgios Androutsopoulos1, Georgios Michail1, Nikolaos Thanatsis1, Charalampos Vitsas1, Emmanouil Terzakis2, Georgios Decavalas1

1Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion, Greece
2Department of Gynaecology, St. Savvas Anticancer – Oncologic Hospital, Athens, Greece

Correspondence: Georgios Androutsopoulos, Assistant Professor, Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion 26504, Greece, E – mail: androutsopoulos@upatras.gr, androutsopoulosgeorgios@hotmail.com


Abstract

Vaginal primary malignant melanoma (VPMM) is a very rare clinical entity. Most patients with VPMM usually have no specific symptoms or signs (abnormal vaginal bleeding, abnormal vaginal discharge, palpable vaginal mass and pain). VPMM has a very aggressive clinical behaviour. Moreover, patients with VPMM are usually diagnosed at advanced stage disease. The extensive vascular and lymphatic network of the vaginal mucosa is a plausible explanation for the aggressive clinical course of VPMM. Surgery is the baseline treatment for the majority of patients with VPMM. Surgical operation may be either conservative (wide local excision) or radical (vaginectomy, pelvic exenteration). Lymph node dissection is not recommended in patients with VPMM, because the possibility for a lymph node metastasis is very low. Radiotherapy is another effective treatment option for patients with VPMM. In particular, the use of radiotherapy includes vaginal brachytherapy and external pelvic radiotherapy. Chemotherapy is most commonly used in patients with advanced stage VPMM, but its clinical role remains controversial. Immunotherapy is usually reserved as postoperative adjuvant treatment and offers survival benefits in patients with VPMM who are in high risk for recurrence. Biochemotherapy is characterized by the combined use of chemotherapy and immunotherapy and is considered for patients with advanced stage VPMM. It becomes apparent that although there are various treatment options for patients with VPMM, because of the rarity of the condition, universally-accepted effective treatment protocols have not been established so far.

Keywords: vaginal primary malignant melanoma, clinical characteristics, treatment, surgery

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