Ovarian Cancer Group, Lowy Cancer Research Centre, School of Women's and Children's Health and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
Gynaecological Cancer Centre, Royal Hospital for Women, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia.
Int J Mol Med. 2014 Apr;33(4):784-94. doi: 10.3892/ijmm.2014.1659. Epub 2014 Feb 14.
Vulvar melanoma is the second most common vulvar cancer. Patients with vulvar melanoma usually present with the disease at a late stage and have a poor prognosis. The prognostic predictors reported in the literature are not unequivocal and the role of lichen sclerosus and c-KIT mutations in the aetiology of vulvar melanoma is unclear. Breslow staging currently seems to be the most adequate predictor of prognosis. We thus performed a clinicopathological and literature review to identify suitable predictors of prognosis and survival and investigated the expression of c-KIT (by immunohistochemistry) in patients with vulvar melanoma (n=33) from the Gynaecological Cancer Centres of the Royal Hospital for Women (Sydney, Australia) and John Hunter Hospital (Newcastle, Australia). Our series of 33 patients fitted the expected clinical profile of older women: delayed presentation, high stage, limited response to treatment and poor prognosis. We identified 3 patients (9.1%) with lichen sclerosus associated with melanoma in situ, although no lichen sclerosus was found in the areas of invasive melanoma. No patient had vulvar nevi. We identified a) Breslow's depth, b) an absence of any of the pathological risk factors, such as satellitosis, in-transit metastasis, lymphovascular space invasion (LVSI) and dermal mitosis, c) removal of inguino-femoral lymph nodes, d) lateral margin of >1 cm, and e) c-KIT expression as valuable prognostic predictors for disease-free survival. We conclude that c-KIT expression is, apart from Breslow's depth, another valuable predictor of prognosis and survival. Lichen sclerosus may be associated with vulvar melanoma.
外阴黑色素瘤是第二常见的外阴癌。外阴黑色素瘤患者通常在疾病晚期出现，并预后不良。文献中报道的预后预测因素并不明确，而且硬化性苔藓和 c-KIT 突变在外阴黑色素瘤的发病机制中的作用也不清楚。Breslow 分期目前似乎是预测预后的最适当指标。因此，我们进行了临床病理和文献复习，以确定预后和生存的合适预测因素，并通过免疫组织化学检测 33 例来自澳大利亚皇家妇女医院（悉尼）和约翰亨特医院（纽卡斯尔）妇科癌症中心的外阴黑色素瘤患者的 c-KIT 表达。我们的 33 例患者系列符合年龄较大女性的预期临床特征：延迟出现、高分期、对治疗反应有限和预后不良。我们发现 3 例（9.1%）患者伴有黑色素瘤原位的硬化性苔藓，尽管在侵袭性黑色素瘤区域未发现硬化性苔藓。没有患者有外阴痣。我们确定了 a）Breslow 深度、b）缺乏任何病理危险因素，如卫星灶、转移灶、淋巴管血管间隙浸润（LVSI）和真皮有丝分裂、c）腹股沟-股淋巴结切除、d）侧缘>1cm 和 e）c-KIT 表达是无病生存的有价值的预后预测因素。我们得出结论，除了 Breslow 深度外，c-KIT 表达也是预后和生存的另一个有价值的预测因素。硬化性苔藓可能与外阴黑色素瘤有关。
