Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2024
Clinicopathologic features and surgical management in vulvovaginal melanoma - A retrospective single-center study.
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Lumiala Telma, Koljonen Virve, Ojala Kaisu
Аннотация
BACKGROUND AND AIMS: Vulvovaginal melanoma is a rare malignancy with a poor prognosis. This study aimed to review cases of vulvovaginal melanoma treated at Helsinki University Hospital. Objective was to evaluate the clinicopathologic features, treatment, and factors affecting outcome.
METHODS: A single-center retrospective review was conducted on patients treated between 2001 and 2021. Data were collected from medical records. Clinicopathologic features, treatment, survival, and prognostic factors were analyzed.
RESULTS: A total of 21 patients were included in the analysis. Localization was vulvar in 86% (n = 18) and vaginal in 14% (n = 3). The median age at diagnosis was 80 years. Initial treatment included surgery in 18 patients (86%), with wide local excision in 19%, radical excision in 62%, and pelvic exenteration in 4.8%. Negative margins were achieved in 83% (n = 15). Eleven (52%) patients underwent inguinal treatment: sentinel lymph node biopsy in 33%, direct lymphadenectomy in 14%, and both in 4.8%. Nine patients experienced melanoma recurrence. Recurrences were locoregional (n = 1), distant (n = 4), and both locoregional and distant (n = 4). Median disease-free survival was 18.9M and median overall survival (OS) was 36.5M. The 5-year relative OS was 20%. Melanoma was the cause of death in seven patients (33%). Vaginal localization tended to worsen prognosis. Nodal status was the only melanoma characteristic significantly associated with survival. Surgical radicality did not affect survival.
CONCLUSIONS: Vulvovaginal melanoma is associated with extremely poor survival rates and high recurrence rates, primarily involving distant metastasis. In local control, wide local excision seems to be a viable alternative to more radical surgery. Nodal status is a key prognostic factor emphasizing the importance of further research into the applicability of sentinel lymph node biopsy for vulvovaginal melanoma.
METHODS: A single-center retrospective review was conducted on patients treated between 2001 and 2021. Data were collected from medical records. Clinicopathologic features, treatment, survival, and prognostic factors were analyzed.
RESULTS: A total of 21 patients were included in the analysis. Localization was vulvar in 86% (n = 18) and vaginal in 14% (n = 3). The median age at diagnosis was 80 years. Initial treatment included surgery in 18 patients (86%), with wide local excision in 19%, radical excision in 62%, and pelvic exenteration in 4.8%. Negative margins were achieved in 83% (n = 15). Eleven (52%) patients underwent inguinal treatment: sentinel lymph node biopsy in 33%, direct lymphadenectomy in 14%, and both in 4.8%. Nine patients experienced melanoma recurrence. Recurrences were locoregional (n = 1), distant (n = 4), and both locoregional and distant (n = 4). Median disease-free survival was 18.9M and median overall survival (OS) was 36.5M. The 5-year relative OS was 20%. Melanoma was the cause of death in seven patients (33%). Vaginal localization tended to worsen prognosis. Nodal status was the only melanoma characteristic significantly associated with survival. Surgical radicality did not affect survival.
CONCLUSIONS: Vulvovaginal melanoma is associated with extremely poor survival rates and high recurrence rates, primarily involving distant metastasis. In local control, wide local excision seems to be a viable alternative to more radical surgery. Nodal status is a key prognostic factor emphasizing the importance of further research into the applicability of sentinel lymph node biopsy for vulvovaginal melanoma.