Lower Genital Tract Melanomas: Staging, Predictors of Outcome, and New Therapeutic Options.

Abstract

Identification of predictors of survival of patients with lower genital tract melanoma (LGTM) and evaluation of the effectiveness of immunotherapy. Data of twenty women with LGTM were retrospectively collected. Survival outcomes were evaluated using the Kaplan-Meier method. Survival distributions were analyzed using the Log rank test. Twenty patients with LGTM (6 vaginal/14 vulvar) were evaluated. Factors significantly affecting Five-year OS was the stage of the American Joint Committee on Cancer (AJCC 2017) (I+II: 55.6% vs. III+IV: 25.9%; p=0.030) and the T-Stage (I+II: 100% vs. III+IV: 7.5%; p=0.280). Factors negatively affecting Five-year PFS was T-Stage >II (p=0.005), AJCC stage >II (p<0.001), depth of tumor infiltration >3 mm (p=0.008), nodal involvement (p=0.013), distant disease (p=0.002), and resection margins <10 mm (p=0.024). Nine patients received immunotherapy [median duration of response (DOR)=4 months]. Three patients received immuno- and radiation therapy (median DOR of 5 months). Two patients received T-VEC, only one responded. Surgery has a therapeutic effect in early stage LGTM. Advanced stages may be treated with immunotherapy, radiation therapy, a combination of both, and oncolytic viral immunotherapy.