Malignant Melanoma of the Vagina - Analysis of Prognostic Factors

Background and Aims: To evaluate the role of radical surgical procedures, radiotherapy, and other prognostic factors associated with survival in patients with vaginal melanoma. Methods: From 1972-2002, patients with primary vaginal melanoma were identified from tumor registry databases at four California academic medical centers. Data collected from hospital charts, office records, and tumor registry files were analyzed using Kaplan-Meier survival analysis, and Cox proportional hazards regression. All slides were rereviewed by two gynecologic pathologists. Results: Of the 20 patients diagnosed with vaginal melanoma, the median age of diagnosis was 68.5 (range: 40-81). Six had FIGO stage I, seven stage II, four stage III, and three had stage IV disease. Eleven patients had conservative surgery (simple excisional vulvectomy, hemivulvectomy, excisional vaginectomy, or simple vaginectomy) followed by radiotherapy, chemotherapy or a combination of these procedures; nine patients underwent a radical surgical procedure (radical vaginectomy or an anterior, posterior, or total pelvic exenteration). Patients who underwent a radical procedure had a significantly improved two-year survival of 88.9% versus 36.4% in those who received conservative management (p ¼ 0.045). However, there was no difference between these two treatments in patients with tumors ,3 cm2 (p ¼ 0.34) and 3 cm2 (p ¼ 0.54). Nine patients who received conservative management and seven patients who underwent a radical procedure had a recurrence, but this difference was not statistically significant (p ¼ 0.88). Conclusion: In this small series, our data suggest that radical surgery may have an important role in the treatment of vaginal melanoma in younger patients with tumors amenable to radical surgery.