How to diagnose and manage malignant melanoma of the vagina, an aggressive melanoma: An evidence-based case report and review

To determine the diagnostic modality and therapeutic management of malignant vaginal melanomas. Evidence-based case report and review, with literature from the PubMed and Cochrane databases. We identified 36 studies, of which seven could be evaluated. One serial case report concluded that melanoma should be diagnosed histopathologically and treated with local resection as the primary treatment, followed by chemotherapy as an adjuvant therapy; a median survival of 419 days post-therapy was reported. One systematic review did not identify significant differences in survival time after radical excision compared with wide local excision (WLE) (median 33 vs. 19 months, P = 0.065). Four studies concluded that wide excisions with thorough removal of the macroscopic tumor and negative-free margins have better survival rates than treatment with primary radiotherapy, and in advanced-stage melanoma cases, palliative chemotherapy is preferred. In any patient with suspected vaginal melanoma, diagnosis should be established by histopathological examination, and staging should be determined based on pelvic examination and radiology work-up. All patients with vaginal cancer should be referred to and treated by a multidisciplinary gynecological oncology team, with WLE as the recommended treatment and chemotherapy and radiation for unresectable cases. Palliative chemoradiation should be considered for advanced-stage disease.