PRIMARY VAGINAL MELANOMA - 13-YEAR DISEASE-FREE SURVIVAL AFTER WIDE LOCAL EXCISION AND REVIEW OF RECENT LITERATURE

OBJECTIVES: We present a case report of a woman who has survived 13 ye ars after conservative treatment with wide excision for vaginal melano ma and review and evaluate the literature on this disease since the la st metaanalysis in 1989.STUDY DESIGN: A database literature search alo ng with cross referencing from related articles uncovered 66 patients who were reported to have vaginal melanoma since 1989 with adequate in formation for our analysis. We add to this one original case reported by us. Where information was available, we analyzed outcomes on these cases on the basis of patient age, tumor thickness, tumor size, and tr eatment. RESULTS: The patient we describe is only the eighteenth repor ted patient to survive vaginal melanoma 5 years and only the third to survive for 10 years. Of the 67 patients in our overall review, mean a ge at the time of diagnosis was 62 years. Patients with tumor size <3 cm had a mean survival of 41 months compared with 12 months for those with tumor size greater than or equal to 3 cm (p < 0.0024). Tumor thic kness did not significantly affect patient survival at any of the dept hs analyzed, although there was a tendency toward significance at dept hs >8 mm (p < 0.0778). There also was no significant difference in pat ient outcome among five treatment groups: (1) wide excision, (2) radic al surgery, (3) radiation therapy, (4) wide excision plus radiation th erapy, and (5) other. CONCLUSION: Tumor size appears to affect surviva l in patients with vaginal melanoma. Tumor thickness, at least at the levels at which vaginal melanomas are currently being diagnosed, does not seem to affect survival. Because no single treatment is clearly pr eferable, we suggest conservative resection where possible. We find it difficult to support radical surgery as primary treatment for vaginal melanoma unless necessary to achieve clear tumor margins. Radiation t herapy appears to offer results comparable to those of surgery.