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. (#*#ref1#*#) 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 (#*#ref2#*#). 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 (#*#ref3#*#).
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 (#*#ref4#*#). 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 (#*#ref5#*#). 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 (#*#ref6#*#). More specifically, the study reports 46% local control, 53% nodal control, 36% distant metastasis-free survival, 49% melanoma-specific survival and 48% overall survival (#*#ref6#*#).
Once again, we would like to congratulate the authors for their excellent anatomic approach/surgery and for raising awareness of such a rare entity.