title: Melanoma of the vulva: a pigmented lesion is also significant in a non-sun-exposed area.
abstract: OBJECTIVE
  The foremost important aetiological factor for malignant melanoma is considered to be sunlight exposure. However, primary lesions are also seen in non-sun-exposed areas. Vulvar melanoma is rare and associated with impaired outcome. Herein, we attempt to increase physicians' awareness for early diagnosis in order to improve prognosis.
  
  
  METHODS
  A 64-year-old female presented with pruritus and irritation at her external genitalia. At examination a pigmented lesion of the vulva 3 cm in diameter was seen. Incisional biopsy revealed melanoma. Clinical examination and imaging studies did not show evidence for metastatic disease. She underwent wide excision of the melanoma with primary wound closure and biopsy of sentinel lymph nodes, which were free of disease. After a follow-up period of 43 months, she remains free of disease.
  
  
  CONCLUSIONS
  Literature review shows that prognosis is poorer than at other sites, most probably due more advanced disease at diagnosis. This case demonstrates that early diagnosis by physicians aware of this malignancy at this relatively rare site is of crucial importance since it may result in improved outcome, similar to that of melanoma at more common sites.
authors.affiliation: Department of Surgical Oncology, Medical School of Crete University Hospital, PO Box 1352, 71110 Herakleion, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Parara
authors.forename: Eelco
authors.initials: E
authors.lastname: de Bree
authors.forename: Dimitris
authors.initials: D
authors.lastname: Takos
authors.forename: Elpida
authors.initials: E
authors.lastname: Giannikaki
authors.forename: John
authors.initials: J
authors.lastname: Melissas
authors.forename: Dimitris D
authors.initials: DD
authors.lastname: Tsiftsis
mesh_terms: D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008545:Melanoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D010858:Pigmentation; D021701:Sentinel Lymph Node Biopsy; D014846:Vulvar Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery