Malignant melanoma of the vagina and locoregional control: Radical surgeryrevisited

Background. Anecdotal reports and retrospective case reviews suggest improv ed locoregional control, and possibly overall survival, with radical surgic al extirpation as the primary management of vaginal melanoma. This study se eks to reevaluate, through case presentation and literature review, the use fulness of radical pelvic surgical procedures in the management of vaginal melanoma. Case. Seven cases of primary vaginal melanoma were seen at the University o f Virginia Hospital from 1966 to 1996; each was compared in terms of primar y management, disease-free interval, sites of relapse, and overall survival . All patients who died of their disease relapsed locally prior to their de ath, 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 disfigu rement associated with more radical surgical resection. The results reporte d here, as well as other published reports, suggest that locoregional contr ol may be obtained with even large melanomas with radiotherapy when adminis tered in high individual fractions (greater than 400 cGy/fx). This type of response is consistent with the higher response rate seen with cutaneous me lanomas when large individual fractions are compared to conventional fracti onation. Because of the extremely poor survival with vaginal melanoma regar dless of primary therapy, novel therapeutic strategies, including further i nvestigation into the use of high-dose fractionation irradiation, are urgen tly needed. (C) 1998 Academic Press.