MALIGNANT-MELANOMA OF THE VULVA - EVALUATION OF PROGNOSTIC FACTORS WITH EMPHASIS ON DNA-PLOIDY IN 75 PATIENTS

Background. To the authors' knowledge, the potential prognostic value of DNA ploidy in vulvar melanoma has not been evaluated in previous se ries. Methods. Clinical data and follow-up information were retrieved from the hospital records of 75 patients treated from 1956 to 1987. Hi stopathologic specimens were reviewed for histologic type, depth of in vasion, vessel invasion, and ulceration. Flow cytometric DNA measureme nts were performed on paraffin embedded samples. Results. Forty-three patients had International Federation of Gynecology and Obstetrics Sta ge I disease, 14 Stage II, 8 Stage III: and 10 Stage IV. Sixty-five pa tients were treated by surgery, six by radiotherapy, and four patients with advanced disease received no therapy. The surgical procedure was local excision in 17 patients, vulvectomy in 22, and radical vulvecto my with inguinal lymph node dissection in 26. Five- and 10-year correc ted survival rates were 46% and 37%, respectively. Recurrences were se en in 43 (66%) of the patients treated by surgery. Independent prognos tic factors for corrected survival in the entire group of 75 patients were inguinal lymph node metastases (P = 0.016), angioinvasion (P = 0. 027), tumor localization to clitoris, and multifocal tumors (P = 0.043 ). For the 65 patients treated by surgery, independent prognostic fact ors for disease free survival were angioinvasion (P < 0.001), age at d iagnosis (P = 0.003), DNA ploidy (P = 0.004), and ulceration (P = 0.02 7). The independent prognostic factors for long term survival were tum or localization to clitoris (P = 0.018), DNA ploidy (P = 0.045), and i nguinal lymph node involvement (P = 0.053). Radical surgery did not im prove disease free or long term survival. Conclusions. DNA ploidy is a n independent factor that predicts prognosis in patients with vulvar m elanoma, and should be considered together with previously known facto rs. Radical surgery does not improve prognosis and is not recommended when the inguinal lymph nodes are clinically negative.