Primary vaginal melanoma is a very rare gynecological malignant tumor
(less than 150 reported cases to-date). Prognosis is poor in spite of
treatment. Due to the fact that only small groups of patients have bee
n compared, conservative treatment has usually been recommended. In re
cent times, radical pelvic surgery has appeared to improve the chances
of survival. We present an unusual case of primitive melanoma of the
upper-third of the vagina with urethral and urinary bladder infiltrati
on in a 47-year-old woman. Treatment consisted of preliminary pelvic b
ilateral lymphadenectomy, anterior exenteration, and urinary bladder r
econstruction according to the Bricker technique. Four months after su
rgical treatment, liver metastases were found. Chemotherapy was initia
ted consisting of 8 cycles every 21 days of fotemustine 100 mg/m(2) (d
ay 1) and dacarbazine (DTIC) 250 mg/m(2) (days 2-5). Interferon alpha-
2-b, 3 MU thrice weekly, for the whole period of chemotherapy, was als
o administered. The patient is in partial remission one year after sur
gical treatment.