Case report of vaginal melanoma

Abstract

Primary malignant melanoma of vagina is a rare disease with a predilection for local recurrence, distant metastasis and short survival time. Due to the low incidence and lack of reporting in the literature, treatment choices still remain controversial. We describe 2 cases of vaginal malignant melanoma. A 42 yr old female presented with complaints of post coital and per vaginal bleed of 1 month duration. Examination findings show growth 6 cm x 6 cm on anterior vaginal wall, another 3 x 3 cm lesion on right lateral vaginal wall. Vaginal biopsy showed malignant melanoma, S-100 and HMB-45 positive while negative for CK and LCA. MRI Whole abdomen showed altered lesion [3.8cm (AP), 6.0cm (TR) and 4.9cm (CC)] in upper 2/3rd of vagina extending into vaginal fornices and abutting right lower cervix superiorly, right paravaginal extension and mesorectal fascia. No significant enlarged lymph nodes were seen. In view of localised disease she underwent Type III Radical hysterectomy with bilateral salpingo-ophorectomy with bilateral pelvic lymphnode dissection with total vaginectomy. Histopathology s/o 2 tumour nodules, one located in the anterior vaginal cuff measuring – 5 x 5 x 3.2 cm, another located in right lateral vaginal cuff measuring 2.5 x 3 x 1.5 cm, malignant melanoma with involvement of the cervix with full thickness stromal invasion (2.8/2.8 cm,) invading perivaginal soft tissue, distance of invasive carcinoma from closest stromal margin <0.1cm (12 O’ clock), LVI, PNI – not seen, all pelvic LN free (0/25). In view of positive margin and full thickness stromal involvement, she received radiotherapy to pelvis and Inguinal region to a dose of 45 Gy/25# followed by a boost of 16 Gy/8# to the tumour bed till 01/01/16. Another case is a 40 yrs female, presented with complaints of bloody discharge per vaginum of 4 months duration. On examination, there was a large growth occupying the vagina till introitus. Cervix normal, para free. MRI Pelvis showed altered lesion involving left lateral uterine cervix and upper 2/3rd of vagina with full thickness stromal involvement with mild left parametrial, anterior and posterior paravaginal extension, measuring 2.9 x 4.5 x 5.3 cm. Few subcmlymphnodes were seen in bilateral external and internal iliac regions (L>R). Vaginal Biopsy was suggestive of Malignant Melanoma, expressing S-100, HMB 45 and SDX-10. Metastatic work up was negative. She underwent RH with total vaginectomy with bilateral PLND with RPLND. HPR showed exophytic black growth seen involving all quadrants of vagina, extending upwards into both lips of cervix – 7 x 6 x 2.5 cm, Malignant melanoma, distance of invasive carcinoma from closest margin: <0.1 cm (paravaginal soft tissue), 3/8 right Pelvic LN, ECE +, 01/9 Left pelvic LN, ECE absent, 0/6 Right common iliac LN, 0/1 Reperitoneal LN was seen. She received adjuvant radiotherapy to a dose of 50 Gy/25# to the pelvis and inguinals→ boost of 6 Gy/3# to nodal regions showing ECE & 10 Gy/5# to the primary region.