title: Malignant melanoma of the vulva: an extension of cutaneous melanoma?
abstract: OBJECTIVE
  To determine the prognostic significance of the 2002 revisions of the American Joint Committee on Cancer (AJCC) Staging System for cutaneous melanoma in melanoma of the vulva and review the current surgical utilized for treatment of this neoplasm.
  
  
  METHODS
  Demographic, surgical and outcomes data were obtained from the records of vulvar melanoma patients treated from 1990 to 2006 at five academic medical centers. The 2002 modifications of the AJCC staging system for cutaneous melanoma, Breslow thickness and Clark level, were applied to all subjects. Kaplan-Meier Modeling and Linear Regression analysis were utilized for data analysis. Statistics were performed with SAS v 9.1.
  
  
  RESULTS
  Seventy-seven patients were identified with a median age of 62 years. 73% had Stage I/II disease. Surgical radicality did not impact recurrence rates or survival. Breslow thickness was associated with recurrence (p=0.002) but not survival. Only the 2002 modified AJCC staging criteria were predictive of overall survival (p=0.006) in patients with malignant melanoma of the vulva.
  
  
  CONCLUSIONS
  In the largest multi-site series of vulvar melanoma, the AJCC-2002 staging system for cutaneous malignant melanoma appears to be applicable to primary vulvar melanoma. Moreover, surgical radicality was associated with significant morbidity but not with improvement in survival. Utilization of standard operative staging and resection principles in cutaneous melanoma should be used for all vulvar melanoma patients. Moreover, these patients should also be considered for enrollment in cutaneous melanoma clinical trials.
authors.affiliation: Division of Gynecologic Oncology, University of Oklahoma HSC, Oklahoma City, OK, USA. katherine-moxley@ouhsc.edu
authors.forename: K M
authors.initials: KM
authors.lastname: Moxley
authors.forename: A N
authors.initials: AN
authors.lastname: Fader
authors.forename: P G
authors.initials: PG
authors.lastname: Rose
authors.forename: A S
authors.initials: AS
authors.lastname: Case
authors.forename: D G
authors.initials: DG
authors.lastname: Mutch
authors.forename: E
authors.initials: E
authors.lastname: Berry
authors.forename: J C
authors.initials: JC
authors.lastname: Schink
authors.forename: C H
authors.initials: CH
authors.lastname: Kim
authors.forename: D S
authors.initials: DS
authors.lastname: Chi
authors.forename: K N
authors.initials: KN
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery