title: Vulvar and vaginal melanoma: case series and review of current management options including neoadjuvant chemotherapy.
abstract: OBJECTIVE
  We report our experience with vulvar (Vu) and vaginal (Va) melanoma, with review of surgical and adjuvant therapy guidelines and description of our use of neoadjuvant therapy in selected cases.
  
  
  METHODS
  We reviewed patients seen at Mayo Clinic for management of Vu or Va melanoma, January 1993-February 2012. Surgical treatment, pathologic and outcome data were abstracted. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and compared between subgroups using the log-rank test.
  
  
  RESULTS
  50 patients underwent surgery for primary or recurrent melanoma (Vu=36, Va=14). The 5-year OS rate was 30.9%, with median OS of 3.3 years. Adjuvant therapy was given to 30.6% of Vu cases with varying combinations of agents. Among Vu patients, after adjusting for node status and depth of invasion, adjuvant therapy was not associated with improved OS (p=0.39) or RFS (p=0.31). Preoperative chemotherapy was used in 2 Va cases. Despite temozolomide followed by exenteration for a 4 cm multi-focal lesion, one patient died within 3 months. The second patient, with a 2 cm vaginal lesion, demonstrated a partial response to carboplatin and paclitaxel (CP). After local excision and lymphadenectomy she received additional CP with bevacizumab and remains disease free at 5 years. CP with bevacizumab was also used in 1 Vu case with a solitary 5 cm midline lesion. She underwent vulvectomy after a partial response, received additional CP and bevacizumab postoperatively, and remains without disease at 2 years.
  
  
  CONCLUSIONS
  Preoperative chemotherapy with CP and bevacizumab may improve treatment outcomes, particularly for Va and large Vu lesions.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA. janco.jomarie@mayo.edu
authors.forename: Jo Marie Tran
authors.initials: JM
authors.lastname: Janco
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000188:drug therapy* / Q000601:surgery*; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000008:administration & dosage; D015996:Survival Rate; D000077204:Temozolomide; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D003606:Dacarbazine; D016190:Carboplatin; D017239:Paclitaxel; D000077204:Temozolomide