title: Vulvar/vaginal melanoma: an updated surveillance epidemiology and end results database review, comparison with cutaneous melanoma and significance of racial disparities.
abstract: OBJECTIVE
  We aimed to compare the differences in demographic features, clinicopathologic features, and survival in patients with vulvar/vaginal melanoma versus cutaneous melanoma with a special emphasis on race.
  
  
  METHODS
  Data were obtained from the Surveillance Epidemiology and End Results database from 1973 to 2008. Kaplan-Meier curves and Cox multivariate model were used for statistical analysis.
  
  
  RESULTS
  Seven hundred sixty-two patients with vulvar/vaginal melanoma and 55,485 patients with cutaneous melanoma patients were included in the study. Twenty-eight patients of the vulvar/vaginal group and 334 patients of the cutaneous group were black (3.6% vs 0.6%, respectively). The median age at the time of diagnosis was 68 years in the vulvar/vaginal group and 52 years in the cutaneous group (P < 0.0001). Three hundred fifty patients (45.9%) in the vulvar/vaginal and 46,499 patients (83.8%) in the cutaneous group presented with localized disease (P < 0.0001), whereas 64 patients (8.4%) in the vulvar/vaginal group and 1520 patients (2.7%) in cutaneous group presented with advanced disease (P = 0.0081). The median survival of the black patients was 16 months in the vulvar/vaginal group and 124 months in the cutaneous melanoma group (P < 0.0001). The median survival in the nonblack population was 39 months in the vulvar/vaginal group compared to 319 months in the cutaneous melanoma group (P <0.0001). In multivariate analysis performed for patients between 1988 and 2008, age, stage, and positive lymph nodes were negative independent prognostic factors for survival in vulvar/vaginal melanoma; whereas age, race, stage, radiation therapy, and lymph node positivity were negative prognostic factors in cutaneous melanoma.
  
  
  CONCLUSIONS
  These findings emphasize that cutaneous and vulvar/vaginal melanomas have different clinicopathologic features and survival patterns.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University and Karmanos Cancer Institute, Detroit, MI 48201, USA
authors.forename: Ismail
authors.initials: I
authors.lastname: Mert
authors.forename: Assaad
authors.initials: A
authors.lastname: Semaan
authors.forename: Ira
authors.initials: I
authors.lastname: Winer
authors.forename: Robert T
authors.initials: RT
authors.lastname: Morris
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008545:Melanoma / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D012878:Skin Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D014625:Vaginal Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D014846:Vulvar Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D000096142:Cutaneous Malignant Melanoma