Letter to the Editor

Vaginal malignant melanoma: surgical challenge and need for combination treatment


  • Christos Iavazzo
  • Panagiotis Peitsidis
  • Ioannis D. Gkegkes

Received Date: 12.04.2023 Accepted Date: 25.05.2023 J Turk Ger Gynecol Assoc 2023;24(3):226-227 PMID: 37675560

To the Editor,

We read the article entitled “Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis” by Vardar et al. (1) with a great deal of interest. The authors present a step-by-step surgical approach for such a challenging case. Mucosal melanomas are a rare type of melanomas in comparison to cutaneous melanomas (2). For this reason, optimal management of locally advanced vaginal melanoma is poorly understood, including exenteration procedures, adjuvant radiotherapy, chemotherapy and immunotherapy with agents such as ipilimumab or nivolumab (3).

A recent systematic review analyzed 15 patients with vaginal melanoma and reported that, in contrast to cutaneous melanoma, there were fewer BRAF mutations and more PI3K/AKT/mTOR pathway alterations, and so early stage and surgical extirpation affected the prognosis (4). However, a combination treatment including application of immune checkpoint inhibitors, radiotherapy and/or anti-angiogenic therapy, may have a synergistic effect in the treatment of patients with advanced vaginal melanoma (5). Moreover, a recent large cohort study from MD Anderson Cancer Center found that mitotic rate >10/mm2, nodal involvement and non-vulvar anatomic subsite were related to poor outcomes, independently of the combination of treatment (6). More specifically, the study reports 46% local control, 53% nodal control, 36% distant metastasis-free survival, 49% melanoma-specific survival and 48% overall survival (6).

Once again, we would like to congratulate the authors for their excellent anatomic approach/surgery and for raising awareness of such a rare entity.

Author's Response

Dear Editor,

The best method to increase our knowledge about rare diseases is sharing data and information. Therefore, we would like to thank Iavazzo et al. for their valuable contribution, and literature-based details about this rare disease.

Yours sincerely,

Mehmet Ali Vardar, Ghanim Khatib, Ahmet Barış Güzel, Ümran Küçükgöz Güleç, Mesut Mısırlıoğlu

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Çukurova University Faculty of Medicine, Adana, Turkey

  1. Vardar MA, Khatib G, Güzel AB, Küçükgöz Güleç Ü, Mısırlıoğlu M. Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis. J Turk Ger Gynecol Assoc 2023; 24: 84-5.
  2. Musheyev Y, Fazylov M, Abramowitz C, Ikhuoriah TA, Rogu P, Levada M. Melanoma in the Vulva of a 71-Year-Old Patient: A Case Report. Cureus 2022; 14: e32698.
  3. Tarhini AA, Hanayneh WB, Powers JJ, Segura CMM, Conejo-Garcia JR, Lam CA, et al. Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma. Front Oncol 2022; 12: 1044587.
  4. Khayyat A, Esmaeil Pour MA, Mousavi S, Khalili-Toosi AR, Amin A. Primary Malignant Melanoma of the Genitourinary System: A Systemic Review and Report of Eight Cases. Cureus 2022; 14: e30444.
  5. Yin P, Ma X, Zhang Y, Song Y, Wang Y, Lu Z. Primary vaginal malignant melanoma successfully treated with combination therapy: A case report. Oncol Lett 2022; 24: 430.
  6. Mitra D, Farr M, Nagarajan P, Ho J, Bishop AJ, Jhingran A, et al. Gynecologic tract melanoma in the contemporary therapeutic era: High rates of local and distant disease progression. Gynecol Oncol 2022; 167: 483-9.