The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Medicine (Baltimore). 2021 Apr 30;100(17):e25691. doi: 10.1097/MD.0000000000025691.
Primary vaginal malignant melanoma is a sporadic and very aggressive tumor that is treated through surgery or radiotherapy combined with chemotherapy. Since most cases are diagnosed at an advanced stage, the operation range is extensive, the quality of life is poor, and the prognosis is gloomy.
A 58-year-old woman presented irregular water-like leukorrhea for 1 month after 6 years of menopause. Positron emission tomography-computed tomography revealed a 3.1 × 2.6 × 3.2 mass on the middle and lower part of the right vaginal wall. A gynecological examination revealed a 2 to 3 cm exophytic black mass in the lower-right part of the vaginal orifice. This mass was 2 cm from the urethral orifice. Furthermore, the mucosa of the anterior inferior vaginal wall had blackened and thickened, and there were some scattered black dots at the medial labia minora.
Due to the patient's symptoms with radiographic findings, the postmenopausal woman was diagnosed with primary vaginal malignant melanoma.
Surgery was done to remove the mass. The patient also underwent inguinal lymph node dissection, received immunotherapy, and was treated with nivolumab.
After a 6-month follow-up period, the patient underwent a routine gynecological examination with negative radiological results. Moreover, no local recurrence or distant metastases were found.
This patient showed a good response to immunotherapy. With this treatment method, the prognosis is better for advanced-stage women, especially those who cannot endure the surgery. Local lesion resection and inguinal lymph node dissection combined with immunotherapy are recommended. The case reported here may help treat similar clinical cases.
原发性阴道恶性黑色素瘤是一种散发性的、侵袭性很强的肿瘤，治疗方法为手术或放疗联合化疗。由于大多数病例在晚期诊断，手术范围广泛，生活质量较差，预后不佳。
一名 58 岁女性绝经 6 年后出现不规则水样白带 1 个月。正电子发射断层扫描-计算机断层扫描显示右侧阴道中下部分有一个 3.1×2.6×3.2 的肿块。妇科检查发现阴道外口右下部分有一个 2 到 3 厘米的外生性黑色肿块，距离尿道外口 2 厘米。此外，前阴道下壁的黏膜变黑变厚，小阴唇内侧有一些散在的黑点。
由于患者的症状和影像学表现，诊断为原发性阴道恶性黑色素瘤。
手术切除肿块。患者还接受了腹股沟淋巴结清扫术，接受了免疫治疗，并接受了纳武单抗治疗。
随访 6 个月后，患者常规行妇科检查，影像学结果阴性。此外，未发现局部复发或远处转移。
该患者对免疫治疗反应良好。对于晚期女性，尤其是不能耐受手术的女性，这种治疗方法的预后较好。建议采用局部病变切除术和腹股沟淋巴结清扫术联合免疫治疗。本例报告可能有助于治疗类似的临床病例。
