Six patients with vulvar malignant melanoma are reported. They accounted fo
r 5.2% of all females with vulvar malignancies diagnosed in the south of Is
rael between 1961 and 1997. Age ranged from 35 to 66 years. Presenting symp
toms were pruritus, bleeding and ulcer. Lesion originated in the labia mino
ra in four patients and the labia majora. in two, and lesion size ranged fr
om to 8 cm. Five patients had nodular melanoma, and one had superficial spr
eading melanoma. Breslow depth ranged from 2.5 to 8 mm, Clark level was IV
in four patients and III in two, and Chung level was IV in all patients. Tw
o patients had radical vulvectomy and bilateral groin lymphadenectomy, one
had wide local excision, and one refused surgery. The two patients who had
radical hemi vulvectomy and bilateral groin lymphadenectomy were given adju
vant active specific immunotherapy with allogeneic vaccine and have survive
d disease-free, whereas the remaining four patients died of disease. It is
concluded that vulvar malignant melanoma is a rare and aggressive tumor. Fo
r patients who present with deep lesions (Breslow depth > 0.76 mm, Clark le
vel > II, Chung level > II) the recommended treatment is wide radical local
excision (or at the most, radical hemivulvectomy) and bilateral groin lymp
hadenectomy.