title: Primary malignant melanoma of the vagina.
abstract: OBJECTIVE
  To describe the clinical and pathologic features of vaginal melanoma and to determine predictors of outcome in patients with this disease.
  
  
  METHODS
  Thirty-seven women with clinical and radiographic stage I vaginal melanoma treated at one institution between 1980 and 2009 were included in this retrospective study. Treatment modalities were assigned to one of three categories: pelvic exenteration, wide excision, and nonsurgical (primary radiation therapy, chemotherapy, or both). Overall survival and progression-free survival were calculated from the date of the surgical diagnosis.
  
  
  RESULTS
  The median age was 60.6 years. Eighty-four percent of patients were white. Vaginal bleeding was the most common presenting symptom. Lesions were located in the distal third of the vagina in the majority (65%) of patients. Initial management included a wide local or radical excision (76% of patients); pelvic exenteration (14%); and radiotherapy, chemotherapy, or radiotherapy and chemotherapy (10%). At a median follow-up of 17.4 months, 33 women experienced disease recurrence. Recurrence was local only in seven patients (22%), distant only in 20 (63%), and both in five (15%). The most common sites of distant recurrence were lungs and liver. Median progression-free survival was 11.4 months, and median overall survival was 19 months. The 5-year progression-free and overall survival rates were 9.5% and 20.0%, respectively. Patients treated surgically had significantly longer survival than those treated nonsurgically (P=.01). Radiotherapy after wide excision reduced local recurrence risk and increased survival from 16.1 months to 29.4 months, although the increase was not significant (P=.46).
  
  
  CONCLUSIONS
  Malignant vaginal melanoma, even when localized at presentation, has a very poor prognosis. Patients treated surgically have longer survival than those treated nonsurgically. Radiotherapy after wide excision reduces local but not distant recurrences.
authors.affiliation: From the Departments of Gynecologic Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Hospital de Clínicas "José de San Martín," Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Mariano
authors.initials: M
authors.lastname: Etchepareborda
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
authors.forename: Charles F
authors.initials: CF
authors.lastname: Levenback
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate; D014625:Vaginal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D055815:Young Adult