Gl. Phillips et al., MALIGNANT-MELANOMA OF THE VULVA TREATED BY RADICAL HEMIVULVECTOMY - APROSPECTIVE-STUDY OF THE GYNECOLOGIC-ONCOLOGY-GROUP, Cancer, 73(10), 1994, pp. 2626-2632
Background. Beginning in 1983, the Gynecologic Oncology Group (GOG) co
nducted a prospective clinicopathologic study of primary malignant mel
anoma of the vulva. The objectives of this study were to determine the
relationship of histopathologic parameters and microstaging to the In
ternational Federation of Gynaecology and Obstetrics (FIGO) staging an
d prognosis. Methods. All patients with primary untreated malignant me
lanoma of the vulva and no history of previous or subsequent other pri
mary invasive malignancy were eligible for study entry. All patients w
ere required to have modified radical hemivulvectomy as minimal therap
y. Groin dissection was optional. Histopathologic specimens were revie
wed for capillary space involvement, Clark's level, Breslow's depth of
invasion, cell type, and melanin distribution. Patient characteristic
s were analyzed in their relationship to groin node status and recurre
nce-free interval. Results. Between 1983 and 1990, 81 patients were en
tered in the study. Of these, 71 were evaluable. Thirty-four patients
underwent radical hemivulvectomy, and 37 patients underwent radical vu
lvectomy. In addition, 56 patients underwent groin node dissection. Th
e factors that were independently correlated with groin node status we
re: capillary lymphatic space involvement (P = 0.0001) and central pri
mary tumor location (i.e,, bilateral/clitoral/T3) (P = 0.003). The oth
er factors that were significant-clinical tumor size, vulvar staging (
FIGO), GOG performance status, and Breslow's depth of invasion-were no
t independent predictors of positive nodes. The factor with the highes
t significant correlation with recurrence-free interval was the 1992 s
taging system of the American Joint Committee on Cancer (AJCC) for mal
ignant melanoma of the skin. Using multiple regression, ATCC stage was
the only independent prognostic factor. In the absence of AJCC stage,
Breslow's depth of invasion was the most prognostic.Conclusion. The b
iologic behavior of vulvar melanoma is similar to other nongenital cut
aneous malignant melanoma.