Primary Vulvovaginal Malignant Melanoma : A Clinicopathologic Review

Shim, J Y; Park, N H; Park, I A; Kim, Y B; Kim, J W; Song, Y S; Kang, S B; Lee, H P

Abstract

Vulvovaginal melanomas are uncommon, and their clinicopathologic characteristics may be different from classic cutaneous melanomas which develop on parts of the body exposed to the sunlight. The objective of this study is to identify the clinicopathologic characteristics of vulvovaginal melanoma and to determine the prognostically significant pathologic factors. A retrospective clinical review was done on 7 cases of primary malignant melanomas of vulvo-vagina treated in Seoul National University Hospital from 1987 through 1996. Pathologic review was performed about the stage including tumor depth and growth pattern, ulceration, mitoses, host response and vascular invasion. The mean age was 51.7 years. The most common symptoms were a palpable mass and bleeding or discharge. Six of 7 patients received radical operations and only one is still alive over 4 years. The others were all dead, and their mean survival time was 17 months. In the pathologic aspects, 4 cases had Chung`s level V and 5 cases were more than 3 mm of Breslow`s tumor depth. The most common morphologic appearance was a nodular type with ulceration, which may be associated with an unfavorable outcome. The role of radical surgery in the management of vulvovaginal melanoma seems to be very limited. The more effective early detection and therapeutic guidelines should be required to achieve an better outcome. Large scaled prospective, randomized trials will be able to provide a decision for the proper surgical management and adjuvant therapy.