Vulvar and Vaginal Melanomas—The Darker Shades of Gynecological Cancers
Abstract
:1. Introduction
2. Risk Factors
3. Clinical Manifestations
4. Histological Aspects
4.1. Macroscopic Examination
4.2. Microscopic Examination
4.3. Histological Subtypes of Melanoma
5. Immuno(cyto)histochemistry in the Diagnosis of Melanoma
6. Molecular Characterization
Mutated Gene | Percentage of Mutation (%) | Details |
---|---|---|
NRAS | 12/67—17.9% |
|
BRAF | 11/67—16.4% |
|
NF1 | 11/67—16.4% | |
KIT | 10/67—14.9% |
|
SF3B1 | 8/67—11.9% |
|
TP53 | 6/67—8.9% |
|
SPRED1 | 5/67—7.4% |
|
ATRX | 4/67—5.9% |
|
HLA-A | 4/67—5.9% | [93] |
CHD8 | 3/67—4.4% | [93] |
7. Melanoma Stage Description
8. Therapeutic Approach
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Number of Patients | Tumor Localisation | Main Signs and Symptoms | Others Signs and Symptoms | References |
---|---|---|---|---|
51 | Labia minora | Pain, Palpable mass, Genital bleeding, Pruritus | Dysuria, Ulceration | [57] |
20 | Labia majora | Genital bleeding, Pruritus, Palpable mass | Pain, Dysuria, Unhealing sore, Urinary difficulties | [36] |
10 | Labia majora | Pruritus | - | [47] |
11 | Not specified | Pruritus, Pain, Genital bleeding | - | [26] |
14 | Labia minora | Pruritus | - | [58] |
31 | Vagina | Genital bleeding, Pain, Palpable mass | Abnormal vaginal secretion, Urinary difficulties | [59] |
33 | Not specified | Palpable mass, Genital bleeding, Pain, Pruritus | Abnormal vaginal secretion, Dysuria, Dyspareunia, Ulceration | [60] |
198 | Unilateral, Clitoris | Genital bleeding, Pain, Pruritus | - | [15] |
Level of Invasion | Clark Classification—Level of Invasion of Cutaneous Melanoma | Chung Classification—Level of Invasion of Mucosal Melanoma |
---|---|---|
I | Lesions involving only the epidermis (in situ melanoma) | Tumor confined to the epithelium |
II | Invasion of the papillary dermis—does not reach the papillary-reticular dermal interface | Tumor penetrates the basement membrane and invades at a depth of <1 mm |
III | Invasion fills and expands the papillary dermis but does not extend to reticular dermis | Tumor invades at a depth of 1–2 mm |
IV | Invasion into the reticular dermis but not into the subcutaneous tissue | Tumor invades at a depth of >2 mm, but without reaching the subcutaneous fat |
V | Invasion through the reticular dermis into the subcutaneous tissue | Tumor penetrates the subcutaneous fat |
STAGE | T (Tumor) | N (Nodules) | M (Metastasis) |
---|---|---|---|
0 | Tis | N0 | M0 |
IA | T1a | N0 | M0 |
IB | T1b, T2a | N0 | M0 |
IIA | T2b, T3a | N0 | M0 |
IIB | T3b, T4a | N0 | M0 |
IIC | T4b | N0 | M0 |
IIIA | T1a/b, T2a | N1, N2a | M0 |
IIIB | T0 | N1b, N1c | M0 |
T1a/b, T2a | N1b/c, N2b | M0 | |
T2b, T3a | N1a-N2b | M0 | |
IIIC | T0 | N2b/c, N3b/c | M0 |
T1a-T3a | N2c, N3 | M0 | |
T3b, T4a | N ≥ N1 | M0 | |
T4b | N1a-N2c | M0 | |
IIID | T4b | N3 | M0 |
IV | Any T, Tis | Any N | M1 |
Tumor Width | Margins | Reference |
---|---|---|
<2 mm | 0.5 cm | [103] |
2 mm | 1 cm | |
>2 mm | 2 cm | |
<1 mm | 1 cm | [98] |
1–4 mm | 2 cm | |
invasion of subcutaneous fat/fascia, any size | >1 cm | |
in situ | 0.5 cm | [15] |
<2 mm | 1 cm | |
>2 mm | 2 cm |
Number of Patients | Mean Depth Invasion | Management | Median Survival (Months) | Reccurence | Reference |
---|---|---|---|---|---|
13 | Not provided | Not provided | 15 | Not provided | [119] |
7 | 8 mm | Wide local excision | 31 | 71% | [118] |
14 | 3.23 mm | 13% Radical surgery and lymphadenectomy 27% Wide local excision and lymph node evaluation 53% Wide local excision | Not provided | 42% | [122] |
9 | 4 mm | Radical surgery and lymphadenectomy | 78 | 32–43% (in situ) | [120] |
85 | 3.2 mm | 12.9% Chemotherapy 24.7% Immunotherapy (IL-2, IFN, vaccine trials) 2.35% Chemotherapy and Immunotherapy 15.29% Radiotherapy 78.8% Surgery | 62.4 | Not provided | [114] |
48 | >3 mm | 29.58% Wide local excision and lymphadenectomy 21.42% Radical surgery (8% pelvic exenteration) | 39.6 | Not provided | [113] |
1917 | Not provided | 95.044% Surgery 10.38% Radiation 9.99% Immunotherapy 5.32% Chemotherapy | Not provided | Not provided | [110] |
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Dobrică, E.-C.; Vâjâitu, C.; Condrat, C.E.; Crețoiu, D.; Popa, I.; Gaspar, B.S.; Suciu, N.; Crețoiu, S.M.; Varlas, V.N. Vulvar and Vaginal Melanomas—The Darker Shades of Gynecological Cancers. Biomedicines 2021, 9, 758. https://doi.org/10.3390/biomedicines9070758
Dobrică E-C, Vâjâitu C, Condrat CE, Crețoiu D, Popa I, Gaspar BS, Suciu N, Crețoiu SM, Varlas VN. Vulvar and Vaginal Melanomas—The Darker Shades of Gynecological Cancers. Biomedicines. 2021; 9(7):758. https://doi.org/10.3390/biomedicines9070758
Chicago/Turabian StyleDobrică, Elena-Codruța, Cristina Vâjâitu, Carmen Elena Condrat, Dragoș Crețoiu, Ileana Popa, Bogdan Severus Gaspar, Nicolae Suciu, Sanda Maria Crețoiu, and Valentin Nicolae Varlas. 2021. "Vulvar and Vaginal Melanomas—The Darker Shades of Gynecological Cancers" Biomedicines 9, no. 7: 758. https://doi.org/10.3390/biomedicines9070758