Malignant melanoma of the vagina and locoregional control: radical surgery revisited.

BACKGROUND: Anecdotal reports and retrospective case reviews suggest improved locoregional control, and possibly overall survival, with radical surgical extirpation as the primary management of vaginal melanoma. This study seeks to reevaluate, through case presentation and literature review, the usefulness of radical pelvic surgical procedures in the management of vaginal melanoma.

CASE: Seven cases of primary vaginal melanoma were seen at the University of Virginia Hospital from 1966 to 1996; each was compared in terms of primary management, disease-free interval, sites of relapse, and overall survival. All patients who died of their disease relapsed locally prior to their death, with the exception of two patients who underwent wide local excision (WLE) followed by postoperative high-dose fractionation teletherapy.

CONCLUSIONS: The use of WLE followed by high-dose fractionation teletherapy in the primary management of vaginal melanoma appears to provide excellent locoregional control, without the attendant morbidity and physical disfigurement associated with more radical surgical resection. The results reported here, as well as other published reports, suggest that locoregional control may be obtained with even large melanomas with radiotherapy when administered in high individual fractions (greater than 400 cGy/fx). This type of response is consistent with the higher response rate seen with cutaneous melanomas when large individual fractions are compared to conventional fractionation. Because of the extremely poor survival with vaginal melanoma regardless of primary therapy, novel therapeutic strategies, including further investigation into the use of high-dose fractionation irradiation, are urgently needed.