Gynaecological Oncology Department, University College London Hospital, London, United Kingdom.
Department of Cellular Pathology, University College London Hospital, London, United Kingdom.
J Low Genit Tract Dis. 2021 Apr 1;25(2):142-145. doi: 10.1097/LGT.0000000000000591.
Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade.
Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist.
We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026).
Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
女性生殖道恶性黑色素瘤是一种罕见疾病，预后较差，其分期和治疗仍存在争议。本研究通过对一家三级癌症中心十年来就诊的女性生殖道黑色素瘤患者的临床、病理和结局数据进行调查。
通过病理报告搜索，回顾性确定患者，以确定 2007 年至 2019 年所有女性生殖道黑色素瘤病例。使用电子患者记录记录临床信息。由妇科和皮肤科病理专家对组织病理学标本进行审查。
我们共发现 30 例生殖道黑色素瘤，其中 19 例为外阴，10 例为阴道，1 例为宫颈。1、3 和 5 年的总生存率分别为 80%、60%和 57%。死亡患者的年龄与存活患者相比无显著差异（62 岁比 69 岁，p =.215）。未发现死亡率与显微镜下溃疡、血管淋巴管浸润、色素沉着、切缘、根治性手术与局部手术之间存在相关性。非外阴病变与外阴病变相比，死亡率显著更高（p =.0018），尽管年龄和 Breslow 厚度相似。5 例患者诊断为原位期，均为外阴。即使排除这些原位黑色素瘤，非外阴黑色素瘤的死亡率仍然显著更高（p =.048）。与外阴病变相比，非外阴病变的色素丧失比例更高（p =.026）。
非外阴生殖道黑色素瘤预后明显较差。生存率与切缘无关，支持使用更保守的手术切缘。
