title: A clinicopathological review of 33 patients with vulvar melanoma identifies c-KIT as a prognostic marker.
abstract: Vulvar melanoma is the second most common vulvar cancer. Patients with vulvar melanoma usually present with the disease at a late stage and have a poor prognosis. The prognostic predictors reported in the literature are not unequivocal and the role of lichen sclerosus and c-KIT mutations in the aetiology of vulvar melanoma is unclear. Breslow staging currently seems to be the most adequate predictor of prognosis. We thus performed a clinicopathological and literature review to identify suitable predictors of prognosis and survival and investigated the expression of c-KIT (by immunohistochemistry) in patients with vulvar melanoma (n=33) from the Gynaecological Cancer Centres of the Royal Hospital for Women (Sydney, Australia) and John Hunter Hospital (Newcastle, Australia). Our series of 33 patients fitted the expected clinical profile of older women: delayed presentation, high stage, limited response to treatment and poor prognosis. We identified 3 patients (9.1%) with lichen sclerosus associated with melanoma in situ, although no lichen sclerosus was found in the areas of invasive melanoma. No patient had vulvar nevi. We identified a) Breslow's depth, b) an absence of any of the pathological risk factors, such as satellitosis, in-transit metastasis, lymphovascular space invasion (LVSI) and dermal mitosis, c) removal of inguino-femoral lymph nodes, d) lateral margin of >1 cm, and e) c-KIT expression as valuable prognostic predictors for disease-free survival. We conclude that c-KIT expression is, apart from Breslow's depth, another valuable predictor of prognosis and survival. Lichen sclerosus may be associated with vulvar melanoma.
authors.affiliation: Ovarian Cancer Group, Lowy Cancer Research Centre, School of Women's and Children's Health and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Viola A
authors.initials: VA
authors.lastname: Heinzelmann-Schwarz
authors.affiliation: Ovarian Cancer Group, Lowy Cancer Research Centre, School of Women's and Children's Health and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Sheri
authors.initials: S
authors.lastname: Nixdorf
authors.affiliation: Gynaecological Cancer Centre, Royal Hospital for Women, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia.
authors.forename: Mehrnaz
authors.initials: M
authors.lastname: Valadan
authors.affiliation: Hunter Area Pathology Service and University of Newcastle, John Hunter Hospital, Newcastle, NSW 2310, Australia.
authors.forename: Monica
authors.initials: M
authors.lastname: Diczbalis
authors.affiliation: School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Jake
authors.initials: J
authors.lastname: Olivier
authors.affiliation: Hunter Centre for Gynaecological Cancer, John Hunter Hospital, Newcastle, NSW 2310, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Otton
authors.affiliation: Gynecological Research Group, Department of Medicine, University Hospital Basel, University of Basel, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Fedier
authors.affiliation: Gynaecological Cancer Centre, Royal Hospital for Women, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia.
authors.forename: Neville F
authors.initials: NF
authors.lastname: Hacker
authors.affiliation: Hunter Area Pathology Service and University of Newcastle, John Hunter Hospital, Newcastle, NSW 2310, Australia.
authors.forename: James P
authors.initials: JP
authors.lastname: Scurry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D049109:Cell Proliferation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008544:Melanocytes / Q000378:metabolism / Q000473:pathology; D008545:Melanoma / Q000276:immunology / Q000378:metabolism* / Q000473:pathology*; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015999:Multivariate Analysis; D011379:Prognosis; D019009:Proto-Oncogene Proteins c-kit / Q000378:metabolism*; D012307:Risk Factors; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000276:immunology / Q000378:metabolism* / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; D019009:Proto-Oncogene Proteins c-kit