Lumiala Telma, Koljonen Virve, Ojala Kaisu
Department of Plastic Surgery, Helsinki University, Helsinki University Hospital, Helsinki, Finland.
Department of Plastic Surgery, Helsinki University, Helsinki University Hospital, Helsinki, Finland.
J Plast Reconstr Aesthet Surg. 2025 Jan;100:8-15. doi: 10.1016/j.bjps.2024.10.035. Epub 2024 Oct 28.
Vulvovaginal melanoma is a rare malignancy with a poor prognosis. This study aimed to review cases of vulvovaginal melanoma treated at Helsinki University Hospital. Objective was to evaluate the clinicopathologic features, treatment, and factors affecting outcome.
A single-center retrospective review was conducted on patients treated between 2001 and 2021. Data were collected from medical records. Clinicopathologic features, treatment, survival, and prognostic factors were analyzed.
A total of 21 patients were included in the analysis. Localization was vulvar in 86% (n = 18) and vaginal in 14% (n = 3). The median age at diagnosis was 80 years. Initial treatment included surgery in 18 patients (86%), with wide local excision in 19%, radical excision in 62%, and pelvic exenteration in 4.8%. Negative margins were achieved in 83% (n = 15). Eleven (52%) patients underwent inguinal treatment: sentinel lymph node biopsy in 33%, direct lymphadenectomy in 14%, and both in 4.8%. Nine patients experienced melanoma recurrence. Recurrences were locoregional (n = 1), distant (n = 4), and both locoregional and distant (n = 4). Median disease-free survival was 18.9M and median overall survival (OS) was 36.5M. The 5-year relative OS was 20%. Melanoma was the cause of death in seven patients (33%). Vaginal localization tended to worsen prognosis. Nodal status was the only melanoma characteristic significantly associated with survival. Surgical radicality did not affect survival.
Vulvovaginal melanoma is associated with extremely poor survival rates and high recurrence rates, primarily involving distant metastasis. In local control, wide local excision seems to be a viable alternative to more radical surgery. Nodal status is a key prognostic factor emphasizing the importance of further research into the applicability of sentinel lymph node biopsy for vulvovaginal melanoma.
外阴阴道黑色素瘤是一种罕见的恶性肿瘤，预后较差。本研究旨在回顾在赫尔辛基大学医院接受治疗的外阴阴道黑色素瘤病例。目的是评估其临床病理特征、治疗方法及影响预后的因素。
对2001年至2021年期间接受治疗的患者进行单中心回顾性研究。从病历中收集数据。分析临床病理特征、治疗方法、生存率及预后因素。
共有21例患者纳入分析。86%（n = 18）位于外阴，14%（n = 3）位于阴道。诊断时的中位年龄为80岁。初始治疗包括18例患者（86%）接受手术，其中19%为广泛局部切除，62%为根治性切除，4.8%为盆腔脏器清除术。83%（n = 15）切缘阴性。11例（52%）患者接受腹股沟治疗：33%行前哨淋巴结活检，14%行直接淋巴结切除术，4.8%两者均行。9例患者出现黑色素瘤复发。复发部位为局部区域（n = 1）、远处（n = 4）及局部区域和远处均有（n = 4）。无病生存期的中位数为18.9个月，总生存期（OS）的中位数为36.5个月。5年相对总生存率为20%。7例患者（33%）死于黑色素瘤。阴道部位倾向于使预后恶化。淋巴结状态是唯一与生存显著相关的黑色素瘤特征。手术根治性不影响生存。
外阴阴道黑色素瘤的生存率极低且复发率高，主要涉及远处转移。在局部控制方面，广泛局部切除似乎是比更根治性手术更可行的选择。淋巴结状态是关键的预后因素，强调了进一步研究前哨淋巴结活检在外阴阴道黑色素瘤中适用性的重要性。
