Introduction/Background Primary vaginal malignant melanoma (PVMM) is a rare cancer of the female genital tract which accounts for 3% of all cancers in the female genital tract1. It is more aggressive than other melanomas. Locally, the annual new number of vaginal cases in 2020 is only 97, however, there is limited published data on melanoma.

Methodology We report a case of PVMM in a 59-year old presenting as vaginal spotting due to a polypoid mass on the lower third of vagina. Biopsy reveals an invasive melanoma. Immunohistochemistry showed diffusely positive for Melan-A and HMB-45 confirming the diagnosis. Computed tomography scan showed bone metastasis. Chemotherapy with Dacarbazine was initiated, however, she succumbed to the disease after 5 cycles.

Results Wide local excision remains the mainstay of management. However, due to its size and location, many are not amenable. Because of limited detailed clinical trial data, there are no consensus recommendations for the management, hence, treatment strategies are individualised.

Conclusion We report a case of PVMM presenting with post-menopausal spotting to promote awareness of this infrequent disease. There has been limited published cases in the Philippines. Despite aggressive therapy, the prognosis is poor for most patients as it is usually diagnosed late. Physicians may consider this in their differential diagnosis for patients presenting with vaginal bleeding in which treatment was not successful. There is a lack of clinical trial data on how vaginal melanoma is treated, however, until more evidence is available, the current recommendation is the same as with cutaneous melanoma.

Acknowledgement The author acknowledges the participation of Dr. Alpha Grace Cabic for providing the histological images.

Conflict of interest None.