Management of Malignant Vulval Melanoma: A Retrospective Case Series and Review of the Literature

Objectives: The aims of the study were to evaluate clinicopathologic features, management, and outcomes in vulval melanoma and to review the literature. Materials and methods: Data were collected retrospectively on patients with vulval melanoma from 2001 to 2017 in 5 gynecological oncology cancer centers (Bristol, Taunton, Truro, Plymouth, and Cheltenham). SPSS software was used for univariate and multivariate statistical analysis. Disease-specific median survival was calculated using Kaplan-Meier curves. Results: Forty-four patients with vulval melanoma were included, with a median age of 71 years. Forty-three of 44 had wide local excision with full inguinal lymphadenectomy if abnormal lymph nodes. Seven patients had sentinel lymph nodes. However, 2 patients with negative sentinel lymph nodes had distant recurrences within 16 months.On univariate analysis, presence of ulceration (p = .012), perineural invasion (p = .03), and area of lesion (p = .016) were associated with risk of recurrence but only presence of microsatellites (p = .01) was associated with risk of death.There were 31 deaths (70%): 29 (94%) of 31 from melanoma and 28 (64%) of 44 recurrences: 17 local (10 groin, 7 vulval) and 9 distant. Overall median survival was 32.5 months (95% CI, 17.8-46.5 months) and median recurrence-free survival 12.6 months (95% CI, 7.7-17.4 months). Conclusions: This retrospective multicenter study highlights the high recurrence rate and poor prognosis of vulval melanoma. Lymph node surgery did not make any difference to recurrence-free survival or overall survival. The presence of microsatellites was associated with a statistically increased risk of death.

Citation

Platt, S., Coleridge, S., Hughes, G., Donkers, H., Wiggans, A., Frost, J., Rolland, P., Julian, S., Morrison, J., Pawade, J., Patel, A., & Newton, C. (2020). Management of Malignant Vulval Melanoma: A Retrospective Case Series and Review of the Literature. Journal of lower genital tract disease, 24(3), 272–276. https://doi.org/10.1097/LGT.0000000000000521

DOI

10.1097/LGT.0000000000000521

URI

https://hdl.handle.net/20.500.14709/946