Mucosal melanoma of the female genitalia: A clinicopathologic study of forty-three cases at Duke University Medical Center

Background. Mucosal melanoma of the female genitalia is a rare neoplasm. Only nine reports reviewing more than 40 patients have been published on this subject in the past 30 years. These lesions arise from melanocytes, which can be found within the mucosa lining the female genital tract. Surgical resection is the mainstay of therapy, with little use for other modalities except in palliative roles. The overall prognosis is poor, with reported 5- year survival rates usually below 50%. Methods. Forty-three patients with primary mucosal melanoma of the female genitalia seen at the Duke University Medical Center Melanoma Clinic during a 25-year period were studied retrospectively. Specific information was obtained from the patients' clinic charts and computerized databases. Results. Thirty vulvar, nine vaginal, and four cervical lesions were identified. The median age at diagnosis was 61.4 years. At initial presentation, two thirds of the patients had localized disease only. Tumor ulceration and thickness of the primary lesion had a measurable impact on prognosis, whereas the presence of regional metastases at presentation did not. All but one patient underwent resection with curative intent. The performance of radical operations did not improve outcome among patients with vulvar melanoma. Many of the treatment failures were the result of local recurrences, hinting at the need to improve local control. Despite therapy, the overall corrected 5-year survival rate was 54%. Conclusions. Prospective multicenter trials for patients with vulvovaginal melanoma could be helpful in establishing uniform, standardized surgical protocols and delineating the applicability of new modalities and therapies, such as lymphoscintigraphy with sentinel node biopsy and high-dose interferon.