Malignant melanoma of the vulva: report of six cases and review of the literature

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.