Introduction/Background Primary vaginal melanoma is a rare carcinoma, representing less than 3% of vaginal carcinomas. It normally presents in postmenopausal women with vaginal bleeding and discharge. No standard of treatment has been established in literature, with poor prognosis after diagnosis, with overall survival rate less then 12 months.
Methodology 62 years old female was referred to our center due to postmenopausal bleeding. Hysteroscopy of uterine cavity was unremarkable, however pigmented lesions in the vagina were revealed. Biopsy confirmed a diagnosis of primary vaginal melanoma. Imaging studies with CT and MRI scan of pelvis; abdomen and thorax have not shown spread of the disease. Results were evaluated by a multidisciplinary team, which recommended surgical therapy. A combined laparotomy and vaginal en bloc resection with radical hysterectomy, bilateral salpingo-oophorectomy and total colpectomy was preformed. Additionally omentectomy, pelvic lymphadenectomy and biopsy of sentinel inguinal lymph nodes were performed.
Results Histopathological examination revealed primary vaginal melanoma in situ with no signs of distal spread, maximum invasion at 1,1 mm, with 10 mm negative margins. No additional therapy was indicated. 6 month after procedure the patient is recovering well, with no sign of relapse. Abdominal ultrasound at check up was unremarkable.
Conclusion Primary vaginal melanoma is a rare carcinoma that can present as postmenopausal bleeding. Our case report highlights that vagina should be evaluated in case of unremarkable examination of uterine cavity. As no standard of treatment has been established, good preoperative imaging and multidisciplinary approach should be considered. Radical excision is the best approach if no signs of distal spread are present.
Disclosure Nothing to disclose
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