Introduction/Background Primary vaginal malignant melanoma is an extremely rare and very aggressive tumor with a 5-year survival rate of 5%-25%. The approach to this disease is a challenge, since staging and treatment data is limited, and the prognosis is poor. Lymph node status and mitotic rate should be assessed as they are the most important predictors of survival.

Methodology We report the case of a 53-year-old woman, subtotal hysterectomized, diagnosed with a primary malignant melanoma of the vagina. On physical examination we can see a hard, cerebroid, non-melanic, pedicled tumour of about 5 cm that depends on the external third of the right lateral face of the vagina.

MRI and PET-CT were performed to plan the surgery.

There was no evidence of extension of the disease to adjacent or distant structures by imaging tests.

A total colpectomy was proposed, and we combined a laparoscopic and vaginal approach to completely remove the tumour

First, a sentinel lymph node biopsy was performed using a hybrid tracer with ICG and Tc99 to detect one inguinal sentinel node bilaterally.

Next, laparoscopic surgery was performed to remove the cervical remanent and to dissect the upper two thirds of the vagina.

Afterwards, the approach to the lower third of the vagina was finished vaginally. We dissected the vagina at the level of the introitus and closure of both sides with Chrobak forceps. Paracolpos was cut and the piece was extracted through the vagina.

Finally, we closed the perineal muscles by planes and performed vaginal cleisis.

Results Despite total vaginectomy, one of the inguinal lymph nodes was affected, which is why the patient has been proposed to complete treatment with immunotherapy. However, the expected outcomes are poor.

Conclusion This video shows the feasibility of performing a complete vaginectomy with a minimally invasive technique by combining a laparoscopic and vaginal approach.

Disclosures There is no standardized therapy for primary melanoma of the vagina but surgical excision either by local wide excision or radical surgery with colpectomy with/without exenteration is the mainstay of treatment.