Vulvar melanoma: report on eleven cases and review of the literature.
OBJECTIVE
Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature.


METHODS
Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo.


METHODS
Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up.


RESULTS
The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months.


CONCLUSIONS
The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method.
Department of Gynecology, Hospital do Cancer A. C. Camargo, São Paulo, Brazil. glbaiocchi@yahoo.com.br
Glauco
G
Baiocchi
João Pedreira
JP
Duprat
Rogerio Izar
RI
Neves
Elza Mieko
EM
Fukazawa
Gilles
G
Landman
Gustavo Cardoso
GC
Guimarães
Leonardo Jacomo
LJ
Valadares
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*