title: Surgical Management and Prognostic Factors of Vulvovaginal Melanoma.
abstract: OBJECTIVE
  The aim of the study was to evaluate the surgical management and the role of different prognostic factors on survival outcomes of women affected by genital (i.e., vulvar and vaginal) melanoma.
  
  
  METHODS
  Data of patients undergoing primary surgical treatment for genital melanoma were evaluated in this retrospective study. Baseline, pathological, and postoperative variables were tested to identify prognostic factors. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox proportional hazards models.
  
  
  RESULTS
  Overall, 98 patients met the inclusion criteria. Sixty-seven (68%) and 31 (32%) patients in this study population were diagnosed with vulvar and vaginal melanoma, respectively. Median (range) DFS and OS were 12 (1-70) and 22 (1-70) months, respectively. Considering factors influencing DFS, we observed that at multivariate analysis, only vaginal localization (hazard ratio [HR] = 3.72; 95% CI = 1.05-13.2) and number of mitoses (HR = 1.24; 95% CI = 1.11-1.39) proved to be associated with worse DFS. Nodal status was the only independent factor influencing 5-year OS in patients with vulvar (HR = 1.76; 95% CI = 1.22-2.54; p = .002) and vaginal (HR = 3.65; 95% CI = 1.08-12.3; p = .03) melanoma.
  
  
  CONCLUSIONS
  Genital melanomas are characterized by a poor prognosis. Number of mitoses and lymph node status are the main factors influencing survival. Surgery is the mainstay of treatment. A correct and prompt diagnosis is paramount.
authors.affiliation: 1Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan; 2Department of Obstetrics and Gynecologic, University La Sapienza, Rome, Italy; and 3Department of Obstetrics and Gynecologic, University of Uruguay School of Medicine, Montevideo, Uruguay.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.forename: Joel
authors.initials: J
authors.lastname: Laufer
authors.forename: Santiago
authors.initials: S
authors.lastname: Scasso
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Alice
authors.initials: A
authors.lastname: Indini
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008545:Melanoma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult