Malignant melanoma of the female genital tract - retort of 9 cases with review of the literature

Abstract

Nine cases of malignant melanoma of the female genital tract were diagnosed 1n the Department of Pathology. University of Hong Kong, from 1978-88. Five cases involved the vagina, two the uterine cervix, one the cervix and vagina, and one the vulva. The primary origin was confirmed histologically 1n 5 cases - 2 vaginal, 2 cervical, and 1 vulval. This distribution contrasts with that 1n the literature where the vulva 1s the most frequently involved genital site, followed by the vagina, and then the cervix. All 5 proven primary melanomas were of the mucosal lentlglnous type. The clinical details were similar to that reported In the literature. The patients mean age was 60yrs, ranging from 37-80yrs, the majority were postmenopausal and the presenting symptoms were per vaginal bleeding or discharge 1n most cases. All cases, except that of an amelanottc melanoma, showed advanced disease at the time of diagnosis with invasion near to 3mm depth by Breslow’s method. This was reflected in the poor prognosis of all our cases. Six of the nine died of the disease within a period of 2-24 months. The three surviving were diagnosed at clinical Stage I and II (FIGO) and have a median survival of 18 months. Pregnancy may have contributed to earlier detection of cervical melanoma in one case. Our observations conform with others who found FIGO clinical stage and Breslow’s tumor thickness to be good prognostic indicators.