Vulvar melanoma: report on eleven cases and review of the literature

• Published in: São Paulo medical journal Vol. 128; no. 1; pp. 38 - 41
• Main Authors: Baiocchi, Glauco, Duprat, João Pedreira, Neves, Rogerio Izar, Fukazawa, Elza Mieko, Landman, Gilles, Guimarães, Gustavo Cardoso, Valadares, Leonardo Jacomo
• Format: Journal Article
• Language: English
• Published: Brazil Associação Paulista de Medicina - APM 01-01-2010; Associação Paulista de Medicina
• Subjects: Aged; Aged, 80 and over; Case Series; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymphadenectomy; MEDICINE, GENERAL & INTERNAL; Melanoma; Melanoma - pathology; Melanoma - surgery; Middle Aged; Neoplasm Staging; Prognosis; Retrospective Studies; Review literature as topic; Sentinel Lymph Node Biopsy; Survival Rate; Vulvar neoplasms; Vulvar Neoplasms - pathology; Vulvar Neoplasms - surgery; Lymphadenectomy; Neoplasias vulvares; Vulvar neoplasms; Review literature as topic; Excisão de linfonodo; Sentinel lymph node biopsy; Melanoma; Literatura de revisão como assunto; Biópsia de linfonodo sentinela
• ISSN: 1516-3180; 1806-9460; 1806-9460; 1516-3180
• DOI: 10.1590/S1516-31802010000100008

Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature.
Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo.
Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up.
The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months.
The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method.