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Malignant melanoma of the vulva is a rare neoplasm that is formed from melanocytes, the cells responsible for the color of the skin. The lesions most often cover the area of the labia majora. The characteristic symptoms of the disease are pain and burning in the vulva area with accompanying bleeding and suspicious vaginal discharge.
What is malignant melanoma of the vulva?
Malignant melanoma of the vulva is a neoplasm of melanocytes from which it develops. It is the second most common cancer after squamous cell carcinoma. Melanocytes are epithelial cells responsible for the color of the skin. Melanoma can be found anywhere in the body, including the labia area. It develops in the area of the unchanged vulva area or in the place where pigmentary changes previously existed. It is a cancer that is difficult to diagnose in the clinical course. It is characterized by an aggressive course, despite its low advancement. The sick person dies within a few months. Melanoma may be chronic and may go unnoticed for several years. This disease most often affects women between 50 and 80 years of age.
Causes of malignant melanoma of the vulva
The risk factors for malignant melanoma of the vulva are:
- occurring lichen sclerosus,
- struggling with chronic inflammations,
- genetic predisposition (in about 10% of patients the disease has a family background),
- HPV human papillomavirus infection,
- immunosuppression due to treatment after transplantation or in AIDS patients.
Note: Unlike other types of melanoma, UV radiation probably does not affect the development of vulvar melanoma.
Malignant melanoma of the vulva – symptoms
The first symptom of malignant melanoma of the vulva is considered to be a tumor and itching. The lesions may appear in the form of single spots and papules or a nodule with uneven edges and a different color. They are usually located in the labia majora, then the labia minora and the clitoral foreskin (usually these are mucous membranes and the hairless area of the vulva, although it can be any part of a woman’s external genitalia). The lesions are generally larger than 7 mm in diameter and sometimes ulcerate. As the disease develops, other symptoms join in, such as:
- pain in the vulva area,
- bleeding from the vulva
- baking,
- itching
- redness and irritation of the vulva,
- suspicious discharge around the vulva,
- discomfort during micturition,
- enlarging the nodes in the groin area.
Malignant melanoma diagnosis of the vulva
Women with suspected moles in the vulva area should see a dermatologist or gynecologist immediately. An indication for a visit and anxiety should be changes that increase in size and have various colors. It happens that the initial diagnosis of malignant melanoma of the vulva is made at the stage of consultation with a gynecologist and performed dermatoscopy. One of the diagnostic methods performed to diagnose melanoma is reflective confocal microscopyIt allows you to visualize the epidermis and the upper layers of the skin in a very good resolution. If a malignant lesion is suspected, it should be surgically removed together with the margin of healthy tissue and sent for histopathological examination, which is crucial. Further treatment procedure depends on its result.
The following parameters should also be considered in the diagnosis of malignant melanoma of the vulva:
- lymphatic infiltration (depth of infiltration of the lesion at the time of diagnosis according to the Breslow scale),
- type of melanoma,
- features of tumor regression,
- type of cellular weaving,
- existing ulcers
- tumor plugs in vessels,
- microsatellitis,
- distance of the edges of the lesion from the cutting line.
Treatment of malignant melanoma of the vulva
Typically, surgery is performed to treat malignant melanoma of the vulva. At an early stage of the disease, local resection of the tumor and inguinal lymph nodes located on its side are performed. This is especially true for tumors located laterally on the labia majora. In extreme cases, a decision is made to perform vulvectomy, i.e. complete removal of the labia, inguinal and femoral lymph nodes, and the mucosa of the lower vaginal wall. The procedure is performed in patients with a depth of infiltration of the lesion exceeding 1 mm. However, the approach to this method is very conservative, because the effectiveness of this method over the less aggressive has not been unequivocally proven.
In turn, systemic treatment uses chemotherapy in combination with immunotherapy.
What’s the prognosis?
Unfortunately, malignant melanoma of the vulva is very often diagnosed too late, which results in unfavorable prognosis. Taking into account the severity of the disease, the five-year survival rate is about 27-60%. The assessment of the stage of melanoma is influenced, among others, by the patient’s age and the involvement of neighboring lymph nodes by cancer cells. The clinical form of vulvar melanoma also plays an important role, e.g. the colorless form has a much worse prognosis. In conclusion, the most important thing is the early detection of vulvar melanoma. The prognosis is more optimistic when treatment is started at an early stage of the disease development.