González-Bosquet J, García Jiménez A, Gil Moreno A, Xercavins J
Department of Gynecologie Surgery/Gynecologie Oncology, Hospital Universitaria Materno-Infantil Vall d'Hebrón, Barceíona, Spain.
Eur J Gynaecol Oncol. 1997;18(1):63-7.
To evaluate the clinical outcome of patients suffering from primary vulvo-vaginal malignant melanoma retrospective review of clinical and pathological data of six patients with vulvar malignant melanoma and one patient with vaginal melanoma was done. Patients were staged using the 1988 FIGO histological classification for vulvar cancer, and the 1992 American Joint Committee on Cancer (AJCC) classification for malignant melanoma of the skin. Clinical features, type of surgery, adjuvant therapy, recurrences, distant metastasis, and survival were recorded. Of 174 primary cancers of the vulva, six were malignant melanomas (3.4%), the second most common cause of vulvar cancer. Within the same period, only one primary vaginal melanoma was detected among 57 primary vaginal cancers (1.7%). The median age of all patients was 71 (range 61-84). We performed different surgical procedures, including a radical local excision of the lesion in the vaginal melanoma, a radical hemivulvectomy in one case, a radical vulvectomy in an other case, and a radical vulvectomy with lymph node dissection en bloc in three cases. According to the 1988 FIGO classification for vulvar carcinomas, three patients were diagnosed as stage I and four as stage III melanomas; and using the 1992 AJCC classification for malignant melanoma of the skin, all patients were staged as stage III. Two out of five patients, with a follow-up longer than two years, continued to live and were disease free at the last check-up (40%): the rest of them (60%) died of disease 2.9 months after the diagnosis of the distant metastasis. Vulvo-vaginal malignant melanomas are neoplasias with a very poor prognosis and a short period of time between the detection of distant metastasis and death. Although treatment is not clear in vaginal melanoma, the most accepted treatment in vulvar melanomas is the radical local excision of the lesion with a homolateral inguinofemoral lymphadenectomy.
为评估原发性外阴阴道恶性黑色素瘤患者的临床结局，我们对6例外阴恶性黑色素瘤患者和1例阴道黑色素瘤患者的临床及病理资料进行了回顾性分析。采用1988年国际妇产科联盟（FIGO）外阴癌组织学分类法对患者进行分期，采用1992年美国癌症联合委员会（AJCC）皮肤恶性黑色素瘤分类法对患者进行分期。记录临床特征、手术类型、辅助治疗、复发情况、远处转移情况及生存情况。在174例原发性外阴癌中，有6例为恶性黑色素瘤（3.4%），是外阴癌的第二大常见病因。在同一时期，57例原发性阴道癌中仅检测到1例原发性阴道黑色素瘤（1.7%）。所有患者的中位年龄为71岁（范围61 - 84岁）。我们实施了不同的手术方式，包括对阴道黑色素瘤患者进行病灶根治性局部切除，1例患者行根治性半侧外阴切除术，1例患者行根治性外阴切除术，3例患者行根治性外阴切除术并整块切除腹股沟股淋巴结。根据1988年FIGO外阴癌分类法，3例患者被诊断为I期黑色素瘤，4例为III期黑色素瘤；采用1992年AJCC皮肤恶性黑色素瘤分类法，所有患者均被分期为III期。5例随访时间超过2年的患者中，2例仍存活且在最后一次检查时无疾病（40%）；其余患者（60%）在诊断远处转移后2.9个月死于疾病。外阴阴道恶性黑色素瘤是一种预后极差、从检测到远处转移至死亡时间较短的肿瘤。虽然阴道黑色素瘤的治疗方法尚不明确，但外阴黑色素瘤最常用的治疗方法是病灶根治性局部切除并同期行同侧腹股沟股淋巴结切除术。
