Primary Malignant Melanoma of Vagina: A Clinicopathologic Analysis of 6 Cases

Abstract

Abstract Introduction/Objective Primary malignant melanoma of vagina (PMMV) has a very high rate of recurrence and poor long-term survival. Less than 250 cases are reported in English literature to date, optimal treatments, risk factors, and prognostic predictors for PMMV are still subjects of debate. This study sought to evaluate the clinicopathologic features, initial management, and survival of 6 patients over 7 years follow-up in one institution. Methods/Case Report In this study, the clinical and pathologic features of 6 PMMV occurring in patients age 49 to 83 years were evaluated retrospectively. The mean age of the patients was 68.2 years, and all patients were postmenopausal women. At the time of diagnosis, all tumors were limited to the vagina. Results (if a Case Study enter NA) Vaginal bleeding, discharge and a tumor mass were the chief complaints. These patients were treated by pelvic exenteration, radical surgery and postoperative chemotherapy and/or radiotherapy. Follow-up was available in all patients ranging from 1 to 7 years. Two patients had metastases in other organs died at 16 and 34 months respectively. Two patients had distant recurrence at 1 to 2 years and are still alive. The other 2 patients have no evidence of disease over 2 years follow-up. Grossly, the tumors were mostly polypoid and ranged from 0.25 to 9.5 cm (mean, 5 cm) in maximum dimension. The depth of invasion ranged from 2.2 to 11 mm. A vertical growth phase was present in all tumors. S-100, HMB-45 and Melan-A were positive in 100% of cases tested. Depth of invasion, mitotic index of tumor cells, tumor size, age, menopausal status, pelvic lymph node metastasis and lymphocytic infiltration show no tendency towards progression-free survival. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins. And adjuvant therapy was associated with progression-free survival. Conclusion In conclusion, PMMV is a rare disease, predominantly seen in women of postmenopausal age, and is associated with a poor prognosis. This study confirms S-100, HMB-45and Melan-A remains the most sensitive marker. Conventional predictors were of no prognostic value. Positive margin and adjuvant therapy were associated with progression-free survival. This report can facilitate the expansion of the phenotypic spectrum of gynecologic melanomas, and contribute to the prevention of misdiagnosis and inadequate treatment of PMMV.