Management of vulvar melanoma and review of the literature

Background: Vulvar melanoma represents a rare group of malignancies and is the second most common vulvar malignancy. Treatment options range from local excision of the tumor and sentinel lymph node dissection to radical resection involving en bloc vulvectomy and inguinofemoral lymphanedectomy. Vulvar melanomas have an overall poor prognosis, and there is lack of consensus in the published literature regarding treatment options. Objective: To discuss the management of vulvar melanomas through review of the actual literature. Methods: Identification of studies through computerized searches (January 2006) was conducted using MEDLINE (1966 to present), the Cochrane Central Register of Controlled Trials, the National Research Register and the Medical Research Council's Clinical Trials Register. The medical subject headings and text words used were: vulvar melanoma, malignant, management, case report, and therapy. The literature review was done over the past 36 years. Result: Results of these primary retrospective series have shown no improvement in the overall recovery or disease survival rates. Conclusion: Patients with malignant melanoma are often diagnosed at 70 years of age with multiple comorbidities. Less radical surgery presents a more realistic option for many patients without decreasing their survival rates. Surgery is still the gold standard of treatment and offers the best available treatment for controlling and potential curing of malignant melanomas. However, the whole concept of therapy should be tailored to meet the specific needs of individual patients.

Malignancy; Melanoma; Vulvar

[1] Stang A., Streller B, Eisinger B, Hickel K.H.: "Population-based incidence rates of malignant melanoma of the vulva in Germany" Gynecol. Oneal., 2005, 96, 216.

[2] Irvin P.W., Legallo R.L., Stoller M.H., Rice L.W., Taylor P.T., Andersen W.A.: "Review vulvar melanoma: a retrospective analysis and literature review". Gynecol. Oneal., 2001, 83, 457.

[3] Weinstock M.A.: "Malignant melanoma of the vulva and vagina in the United States: patterns of incidence and population-based estimates of survival". Am. J. Ohstet. Gynecol., 1994, 171, 1225.

[4] Ragnarsson-Olding B., Johansson H., Rutqvist L.E., Ringborg U "Malignant melanoma of the vulva and vagina: trends in incidence, age distribution and long term survival among 245 consecutive cases in Sweden 1960-1984". Cancer, 1993, 71, 1893.

[5] Hewett P.: "Sequel to a case of recurrent melanosis of both groins and back; The disease reappearing in the brain, heart, pancreas, liver, and other organs". Lancet, 1861, 263.

[6] Wechter M.E., Gruber S.B., Haefner H.K., Lowe L., Schwartz J.L., Reynolds K.R. et al.: "Yul var melanoma: a report of 20 cases and review of tbe literature". Am. Acad. of Dermatol., 2004, 50, 554.

[7] Egan C.A., Bradley R.R., Logsdon V.K., Summers B.K., Hunter G.R., Vanderhooft S.L.: "Vulvar melanoma in childhood". Arch. Dermatol., 1997, 133, 345.

[8] Valverde P., Healy E., Sikkink S., Haldane F., T hody A.J., Carothers A. et al.: "The Asp84Glu variant of the melanocortin 1 receptor (MClR) is associated with melanoma". Hum. Mol. Genet., 1996, 5, 1663.

[9] van der Velden P.A., Sandkuijl L.A., Bergman W., Pavel S., van Mourik L., Frants R.R., Qruis N.A.: "Melanocortin-1 receptor variant R151C modifies melanoma risk in Dutch families with melanoma". Am. J. Hum. Genet., 2001, 69, 774.

[10] Gantz I., Yamada T., Tashiro T., Konda Y., Shimoto Y., Miwa H., Trent J.M.: "Mapping of the gene encoding the melanocortin-1 (alpha-melanocyte stimulating hormone) receptor (MCIR) to human chromosome l 6q24.3 by fluorescence in situ hybridization". Genomics, 1994, 19, 394.

[11] American Joint Committee on Cancer. AJCC cancer staging handbook. 5th edition. Philadelphia, PA: Lippincott-Raven, 1998, 153.

[12] Balch C.M., Buzaid A.C., Soong S., Atkins M., Cascinelli N., Coit D. et al.: "Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma". J. Clin. Oneal., 2001, 19, 3635.

[13] Holschneider C.H., Berek J.S.: Chapter 33: Vulvar Cancer. Novak's Gynecology 13'" edition. New York, Lippincott Williams & Wilkins, 2002.

[14] Abramova L., Parekh J., Irvin W.P., Rice L.W., Taylor P.T., Anderson W.A., Slingluff C.L.: "Sentinel node biopsy in vulvar and vaginal melanoma: presentation of six cases and a literature review". Ann. Surg. Oneal., 2002, 9, 840.

[15] Ragnarsson-Olding B.K.: "Primary malignant melanoma of the vulva: An aggressive tumor for modeling the genesis of non UV light-associated melanomas". Acta Oncologica, 2004, 43, 421.

[16] Thoelke A., Willrodt S., Hauschild A., Schadendorf D.: "Primary extracutaneous malignant melanoma: a comprehensive review with emphasis on treatment". Onkolog比，2004,27, 492.

[17] Tsao H., Atkins M.B., Sober AJ.: "Medical progress: management of cutaneous melanoma". NEJM, 2004, 351, 998.

[18] Heaton K.M., Sussman J.J., Gershenwald J.E. et al.: "Surgical margins and prognostic factors in patients with thick (> 4 mm) primary melanoma". Ann. Surg. Oneal., 1998, 5, 322.

[19] Rose P.G., Piver M.S., Tsukada Y, Lau T: "Conservative therapy for melanoma of the vulva". Am. J. Obstet. GynecoL, 1988, 159, 52.

[20] Bradgate M.G., Rollason T.P., McConkey C.C., Powell J.: "Malignant melanoma of the vulva: a clinico-pathological study of 50 women". Br. J. Obstet. Gynaecol., 1990, 97, 124.

[21] Trimble E.L., Lewis J.L., Williams L.L., Curtin J.P., Chapman D., Woodruff J.M., Rubin S.C., Hoskins W.J.: "Management of vulvar melanoma". GynecoL Oneal., 1992, 45, 254.

[22] Tasseron E.W.K., Van der Esch E.P., Hart A.A.M., Brutel de la Riviere G., Aartsen E.J.: "A clinicopathological study of 30 melanomas of the vulva". Gynecol. Oneal., 1992, 46, 170.

[23] Trimble E.L.: "Melanomas of the vulva and vagina". Oncology, 1996, JO, 1017.

[24] Raeber G., Mempel V., Jackish C., Hundeiker M., Heinecke A., Kuerzl R. et al.: "Malignant melanoma of the vulva: report of 89 patients". Cancer, 1996, 78, 2353.

[25] Scherstroen M., Trope C., Kaern J., Pettersen E.O., Abeler V.M., Kristensen G.B.: "Malignant melanoma of the vulva: evaluation of prognostic factors with emphasis on DNA ploidy in 75 patients" Cancer, 1995, 75, 72.

[26] DeMatos P., Tyler D., Seigler H.F: "Mucosa! melanoma of the female genitalia: a clinicopathologic study of forty-three cases at Duke University Medical Center". Surgery, 1998, 124, 38.

[27] Ragnarsson-Olding B.K., Nilsson B.R., Kanter-Lewensohn L.R., Lagerloef B., Ringborg U.K.: "Malignant melanoma of the vulva in a nationwide, 25-year study of 219 Swedish females: predictors of survival". Cancer, 1999, 86, 1285.

[28] Verschraegen C., Benjapibal M., Suprakarapongkul W., Levy L., Ross M., Atkinson E. et al.: "Vulvar melanoma at the M.D. Anderson Cancer Center: 25 years later". Int. J. Gynecol. Cancer, 2001, 11, 359.

[29] Balch C.M., Wilkerson J.A., Murad T.A. et al.: "The prognostic significance of ulceration of cutaneous melanoma". Cancer, 1980, 45, 3012.