Search

Primary malignant melanomas (MM) originating from the gynecological tract are rare. They respond poorly to immunotherapy when compared with cutaneous MM. This study reports two cases. The first is of a 54-year-old woman with a cervical amelanotic polypoid mass who was diagnosed as having stage IB1 cervical melanoma according to the International Federation of Gynecology and Obstetrics system. At 17 months post-surgery, a computed tomography examination revealed recurrence of a 68 mm pelvic tumor. The second case is of a 37-year-old woman with a 7 cm hemorrhagic mass on the vaginal wall. The patient was diagnosed as having stage IV vaginal melanoma according to the American Joint Committee on Cancer definition. Both patients received nivolumab therapy, programmed cell death receptor 1 monoclonal antibodies, and the tumors almost disappeared. These cases may add the possibility of using colposcopy with narrow-band imaging and positron-emission tomography to diagnose and evaluate primary MM.

Background Malignant melanoma of the lower genital tract is a rare disease known to have a poor prognosis. Because of the high rate of distant metastasis and unsatisfactory survival benefit, a more conservative treatment approach, instead of extensive surgery, may be warranted. Gynecological melanoma is a radioresistant tumor, an ideal disease to test the biological efficacy of carbon ion radiotherapy (CIRT). Aim To report our preliminary experience with CIRT in the treatment of gynecological melanoma at the National Center of Oncological Hadrontherapy (CNAO). Patients and methods Between January 2016 and February 2017, four patients were admitted for CIRT at CNAO. A case of cervical melanoma was treated with palliative aim because of large volume macroscopic disease, while three cases of vaginal melanoma were irradiated with a total dose of 68.8 Gy (relative biological effectiveness) in 16 fractions delivered over 4 weeks (4 days a week). Results The age of women ranged between 49 and 72 (median=60.5 years) years. Treatment was well tolerated in all patients and all women completed the scheduled treatment course. During CIRT, toxicity was mild. For patients with vaginal disease, local control was 10.23 and 12.6 months, while that for cervical malignant melanoma was 7.3 months. All patients experienced systemic progression, with median distant metastasis-free survival of 11.7 months. The median overall survival for the whole patient group was 11.41 months. Conclusion In our first experiences, CIRT appears to be a safe non-invasive option for malignant melanoma of the lower genital tract, but more data and longer follow-up are necessary in order to evaluate the effectiveness and late effects.

This is the case report of primary malignant melanoma (MM) of uterine cervix treated by immune checkpoint inhibitor: the Pembrolizumab. Despite the merge of the novel drugs that has been strikingly improving prognosis of MM, we still struggle treatment of MM of uterine cervix that has aggressive characteristics with unknown etiology. We present our case to contribute its rarity of the disease case report, the primary MM of the uterine cervix that had poor response to pembrolizumab and had OS of 6 months. The treatment ineffectiveness is mainly considered for mucosal MM of low tumor mutation burden and its unusual type of pathology. Accumulation of retrospective studies exclusively on cervical melanoma needs to be proceeded to investigate on characteristics between poor and long survival to establish standardized treatment.

Introduction/Background Malignant melanomas of the female genital tract (FGT) are rare and carry poor prognosis.They have a poorly characterised natural history & lack consensus on optimal management. We reviewed the 12 year experience of a tertiary centre treating this disease. Methodology A text search of the pathology reporting system was used to identify all FGT malignant melanoma cases from 2007 to present. Electronic patient records were used to record clinical information. Histopathology was reviewed by a gynaecological and dermatological pathology specialist. Data were analysed using Chi square, Mann-Whitney-U, or Student9s t-test. Results We identified 30 cases of FGT melanoma; Mean age at presentation was 64 years (range:32–87). Median Breslow thickness was 4.55 mm. 17 patients were treated by wide local excision, 12 by radical surgery and 3 received no surgical treatment. Median follow-up time was 67 months. Survival rates at 1, 3 and 5 years were 87%, 70% and 67% respectively. 19 presented with lower (vulvar) and 11 presented with upper FGT (vaginal or cervical melanoma). Upper FGT lesions were significantly associated with higher mortality compared to vulval lesions (p=0.002).5 patients were diagnosed at in-situ stage, all of these were lower FGT. Even after removing these from analysis, upper genital tract melanomas were still significantly associated with mortality (p=0.01). There was no association between Breslow thickness and site (p=0.156), or mortality (p=0.857). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, or completeness of primary excision. Conclusion This case series, one of the largest available, helps to further demonstrate the natural history of this rare disease. Patients presented at advanced stage, indicated by high Breslow thickness. Upper FGT melanomas had significantly poorer prognosis than lower FGT melanomas, which was not fully explained by a difference in stage. Disclosure Nothing to disclose

Introduction/Background Cervical cancer is one of the most common cancers of the female genitalia in the world. It affects medium-aged and older women above all. Primary malignant melanoma of the uterine cervix is a rare entity characterized by its aggressive development and its poor prognosis. We expose a case of cervical melanoma in an 82 years old woman and its treatment. Methodology Case report and treatment. Results An 82 years old woman came to our hospital with vaginal bleeding since several months. There were nothing of interest in her clinical history and she had started menopause at 58. The speculum examination revealed a friable, irregular mass in the anterior lip, measuring 3 centimeters of diameter. The biopsy concluded to a cervical melanoma. TC and PET-CT were performed and they suggested that the tumor was not spread. A radical hysterectomy and pelvic pelvic node dissection was performed. The final stage was pT3b, N0, M0, and the pathological analysis confirmed that the lesion was a cervical melanoma BRAF V 600. She did not receive chemotherapy. Five months after the surgery she referred vaginal bleeding and was diagnosed with local recurrence of the tumor, confirmed by biopsy. On PET-CT one nodule over the vaginal dome was seen, consistent with recurrence, also deposit of tracer in rectum to be evaluated with colonoscopy. Conclusion Primary cervical melanoma is a rare tumour. The cases are reported in postmenopausal women, with vaginal bleeding. These tumours have a poor prognosis with usual survival of less than 2 years, despite aggressive surgery. Disclosure Chelea IG: ‘I have no conflict of interest’ Canovas Morales E: ‘I have no conflict of interest’ Jara Galvez R: ‘I have no conflict of interest’ Cazorla Amoros E: ‘I have no conflict of interest’.

Malignant melanoma of the genital tract is a rare disease that is usually diagnosed by chance. When a definite diagnosis is delayed, the prognosis is very poor without standardized treatment. Herein, we describe a 40-year-old patient who presented with a history of bloody vaginal discharge for 7 months. Gynecological examination showed an exophytic, hard and pigmented cervical mass involving the upper vagina. The patient was diagnosed with cervical melanoma after a punch biopsy and underwent a radical hysterectomy, upper vaginectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. After surgeries, the patient underwent 2-cycles of adjuvant immunotherapy with pembrolizumab, but died within 8 months. In this report, treatment with pembrolizumab after radical surgery was not effective for this patient who had a primary cervical melanoma that metastasized to bone and lung tissue. We do not know why pembrolizumab was ineffective for this patient, but there are several possible explanations; further research is needed.

Background Primary cervical melanoma is rare; this is especially true of extradural melanoma arising in the nerve root. Characterizing these cases can provide a basis for improved melanoma management. Case Description A 42-year-old female patient with numbness and pain in the right shoulder and arm persisting for 5 years was admitted. Preoperative magnetic resonance imaging revealed an epidural ladle-shaped mass shape beyond the C7-T1 intervertebral foramen that resembled a nerve sheath tumor. Histopathologic analysis following complete resection confirmed the lesion as malignant melanoma. Radiotherapy and temozolomide and cisplatin chemotherapy were administered in an accompanying hospital with regular follow-ups at our institution. After 2 months of postoperative adjuvant therapy, hepatic metastatic lesions developed. The chemotherapy regimen was changed to carboplatin, nab-paclitaxel, and recombinant human endostatin injections for a 6-month period. Follow-up 8 months after chemotherapy (16 months post surgery) indicated a good prognosis. Conclusions In the past 10 years only 1 case of primary extradural spinal melanoma in cervical intervertebral foramen has been described, with no reported cases of hepatic metastasis. As radiographic results are not unequivocal, a diagnosis of spinal melanoma must be based on postoperative histologic confirmation. However, to date there is no standard postoperative adjuvant therapy for these patients. The chemotherapy regimen described in this report has broader implications for melanoma treatment.

Genital melanoma is a rare pathology. We present the experience of two comprehensive cancer centers in Lyon (France) in the management of genital melanoma in order to identify prognostic factors and optimal treatments. Between April 1992 and Mars 2014, 16 patients with a primary genital melanoma were referred to our department. Nine patients presented a vaginal melanoma, six vulvar melanomas and only one cervical melanoma. The median dimension of the lesion was 33.7 mm (5–100 mm). The AJCC stage ranged from IB to IIIC. 12 cases were the classic dark-blue flat melanoma and the other 4 cases were an atypical amelanotic tumor. Wide local surgery was performed in nine patients. A radical surgery was performed in six patients. In the large cervical melanoma, radiotherapy was performed as first-line treatment. In all the patients regional lymph node staging was performed. Adjuvant treatment was realized in nine patients. Two patients are alive without recurrence. Only one patient was lost to the first follow-up. The other 13 patients experienced a rapid recurrence. The median disease-free survival and the median overall survival were 11.8 months (2–49 m) and of 30.4 m (11–144 m), respectively. The disease-free survival and overall survival could be linked to a clinical presentation (Breslow thickness and morphology of lesion) associated to the early diagnosis. In our small series, the most important prognosis factor remains the tumor thickness. These rare lesions should be treated in experienced centers in order to improve their prognostic.

Primary malignant melanoma of the female genital tract is very rare, and most of the melanomas reported till date are of the vulva and only less than 2% are accounting for cervical melanomas. The prognosis cervical melanoma is poor regardless of the stage at the time of diagnosis. There is no standard treatment; however, radical surgery is the cornerstone of treatment. We report a case of cervical malignant melanoma who presented with watery discharge per vaginum and occasional postmenopausal bleeding.

Primary melanomas originating from the gynecological tract are rare and aggressive cancers. The vulva is the most frequent site (70%), followed by vagina and more rarely by cervix. The clinical outcome of patients with female genital tract melanoma is very poor, with a 5-year overall survival (OS) of 37-50% for vulvar, 13-32% for vaginal, and approximately 10% for cervical melanoma. In this systematic review, we analyzed the pathogenesis and the different factors influencing the prognosis of melanomas of the lower genital tract, with particular emphasis on biologic variables that may influence new therapeutic approaches. We evaluated the different treatment modalities described in the literature, in order to offer a possible algorithm that may help the clinicians in diagnosing and treating patients with these uncommon malignancies.

This chapter focuses on tumors not covered elsewhere in the book. These include neuroendocrine tumors, adenosquamous carcinoma, glassy cell carcinoma, basaloid tumors, melanocytic lesions, germ cell tumors, hematologic disorders and secondary tumors.

Rationale Primary melanomas of the female genital tract are rare and usually occur in the vulva and vagina. Involvement of the cervix, uterus, and ovary are extremely rare. Surgery and adjuvant therapy remain the mainstay of treatment. The majority of patients experience poor long-term survival. This report aimed at highlighting an extremely rare case of primary melanoma of the female genitalia, synchronously involving the vulva and uterine cervix. Patient concerns A 58-year-old multiparous female presented with postmenopausal bleeding for 10 days. Diagnoses Speculum examination and histologic analysis of the surgical specimens revealed synchronous involvement of the vulva and uterine cervix by malignant melanoma. According to the American Joint Committee on Cancer stage grouping for melanoma, this tumor was at stage V. Interventions The patient subsequently underwent radical surgery and postoperative chemotherapy. Outcomes She has been on regular follow-up, and is now free of disease for 50 months after the operation. Lessons Primary melanomas of the female genital tract have biologically aggressive characteristics. Optimal management consists of individualized surgery and adjuvant therapy. However, early recognition and prompt intervention offer maximal benefit from treatment.

Background Primary ovarian and cervical melanomas are extremely rare tumors with a poor prognosis. Diagnosis requires a high index of suspicion as presentation can mimic benign conditions clinically and other neoplasms histologically. Cases A 41 year-old with an adnexal mass underwent surgical staging for a stage IA ovarian melanoma. Imaging revealed a brain metastasis treated with radiation. Subsequent nodal recurrence was treated with immune and targeted therapies. She is alive with disease at 61 months follow-up. A 54 year-old presented after endocervical melanoma was diagnosed with polypectomy. She underwent radical hysterectomy, lymphadenectomy, and adjuvant brachytherapy. Immediate post-treatment imaging revealed widespread liver and pulmonary metastasis, currently being treated with ipilimumab. Conclusion Immunohistochemistry can facilitate the diagnosis of gynecologic melanoma, and multidisciplinary treatment is recommended., Highlights • Ovarian and cervical melanomas are rare tumors that present diagnostic challenges. • Survival is poor, and multidisciplinary treatment is recommended. • Immunotherapy should be considered in the treatment of gynecologic melanoma.

We describe 2 new cases of malignant melanoma with divergent rhabdomyoblastic differentiation occurring in adult patients. The patients were women aged 67 and 51 years with primary cutaneous and uterine cervical melanoma, respectively. Rhabdomyoblastic differentiation in melanoma is very rare in adult patients, and to our knowledge, only 7 such cases have been described in the world literature, of which only 4 have conclusive documentation of the presence of rhabdomyoblastic differentiation. We present the fifth and sixth cases of adult melanomas with conclusive divergent rhabdomyoblastic differentiation, including the first noncutaneous (cervical) case; we also review the literature and highlight the potential for underrecognition of this phenomenon.

A 68-year-old woman presented with symptoms of bleeding per vaginum. On examination, a growth was seen in the cervix, clinically considered to be squamous cell carcinoma. The growth was confined to the cervix and did not involve the parametria. However, on biopsy it was diagnosed as malignant melanoma. She underwent surgery elsewhere and was advised chemotherapy as these tumours are aggressive; however, she refused chemotherapy. She has been on regular follow-up and has an ongoing survival and disease-free period of more than 5 years. Primary cervical malignant melanomas are very rare as compared with vulval and vaginal counterparts and should be considered in the histological differential diagnosis of poorly differentiated malignant neoplasms involving cervix. Moreover, it is important to rule out metastasis from common primary sites such as skin, oesophagus, uveal tract and anorectal region before considering diagnosis of primary cervical melanoma.

This is a case report and review of the literature on primary melanoma of the cervix. There have been only 26 published cases of primary cervical melanoma and most are poorly documented and doubtful. The patients' ages ranged from 26 to 78 years old with a mean age of 55 +/- 13 years. The main presenting symptom was vaginal bleeding (83.0%). The majority of the patients, 88%, presented in stage I or II. Treatment varied from a simple excision of a cervical mass to a radical hysterectomy with lymph node dissection and adjuvant radiation or chemotherapy. Our patient presented with vaginal bleeding and was diagnosed as having stage IIa cervical melanoma. She underwent a radical hysterectomy, partial vaginectomy, and pelvic and paraaortic lymph node dissection. She received adjuvant radiation therapy and her survival was 29 months. The prognosis of primary cervical melanoma is usually poor and unpredictable. We recommend a radical hysterectomy and vaginectomy, if necessary, to obtain negative surgical margins of at least 2 cm. We advocate lymphadenectomy only for grossly positive nodes.

A 63-year-old patient with a malignant melanoma of the uterine cervix is described. Subtle epitheliotropism of the neoplastic cells within the endocervical columnar epithelium suggested melanoma in situ and the possibility of a primary uterine cervical melanoma, despite a negative anti-S-100 protein immunohistochemical stain. An exhaustive clinical workup, and ultimately, complete autopsy failed to reveal any other primary tumor site, and the diagnosis of melanoma was confirmed by histology and immunohistochemistry on the hysterectomy specimen. A world literature review revealed 54 previously reported cases of uterine cervical melanoma of which 43 had been reported as primary uterine cervical melanoma. A true intraepithelial melanocytic component was found in only 14 of those cases, however, and none of those reports illustrated this with the clarity with which it was seen in the endocervical glandular and surface columnar epithelium of the present case. Primary uterine cervical melanoma is usually discovered at an advanced stage and is no longer amenable to curative therapy. Even when this tumor is discovered early, however, the diagnosis may be unnecessarily delayed if the often subtle interaction of the neoplastic cells with the benign cervical squamous or glandular epithelium is not appreciated, or if the possibility of malignant melanoma is not entertained based on other histologic or immunohistologic characteristics of the tumor cells.

Primary spinal melanoma is a very rare condition: to date < 60 cases have been reported in the literature. A 48-year-old man presented with a 6-month history of upper- and lower-extremity numbness. Spinal magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C2 – C6 level. This was confirmed as a melanoma by immunohistochemistry. Cerebral MRI showed multiple lesions with the same signal characteristics as those seen in the spinal lesion on MRI. Complete skin, mucosal and retinal examination failed to show any primary lesion, therefore a diagnosis of primary cervical melanoma with brain metastases was made. To our knowledge this is the first report of a primary melanoma of the cervical spine with cerebral metastases at the time of diagnosis. This article presents pertinent reported literature and discusses the aetiology, diagnosis, treatment and prognosis of this unusual condition.

Malignant melanoma of the uterine cervix is a rare extracutaneous melanoma which develops aggressively and is associated with a bleak prognosis. To our knowledge, no prior published reports have discussed the role of 18F-FDG positron emission tomography/computed tomography (PET/CT) in managing this disease. Our case study involved a 66-year-old woman with a malignant melanoma of the uterine cervix. The patient received PET/CT that identified metastases and lesions which had not been detected from her MRI. Serial PET/CT elucidated that the disease was initially limited to the pelvis, but then metastasized to the abdominal para-aortic lymph nodes, followed by extensive metastases to the brain, lungs, breast, supraclavicular, neck, and other abdominal lymph nodes, as observed at 6-month follow-up. PET/CT was used to complement conventional anatomic imaging modalities, and provided a novel modality for whole body screening. Visualization of the metabolic activity of indeterminate lesions may help in staging, re-staging, treatment planning, and prognostic prediction for patients with this rare disease.

A 20-year-old caucasian woman with a 5-year history of right arm, neck, and back pain sought treatment when an automobile accident (4 months before admission) exacerbated her pain. Magnetic resonance imaging revealed an intra- and extradural mass compressing the spinal cord at the C5-C6 level. It also extended into and widened the neural foramen, mimicking a neurofibroma. A single cafe-au-lait spot was discovered in the inguinal region. A two-staged surgical resection was performed on an apparent hemorrhagic C6 nerve root mass. The mass exhibited diagnostic features of a malignant melanoma histologically, immunocytochemically, and ultrastructurally. A search for a primary lesion outside the nervous system or other metastases during an 8-year period from the onset of symptoms has been negative. The patient's chronic history, evidence of neural foraminal enlargement, and the absence of other malignant melanoma lesions or subsequent metastases indicates that this lesion may be a primary melanoma of the nerve root with a benign course.

To present a case of primary malignant melanoma of the cervix. The patient was admitted with the complaint of vaginal bleeding. Gynecological examination revealed a dark, papillary mass on the posterior lip of the cervix. Histopathology showed a malignant neoplasm with increased vascularity, indicating the possibility of a primary uterine cervical melanoma. Diagnosis of malignant melanoma was confirmed with immunohistochemistry, which showed diffuse positive reactions for S-100 protein and HBM-45, with no reaction for epithelial markers, namely cytokeratin AE1/AE3 and epithelial membrane antigen. An extensive search for a melanotic lesion in skin and in uveal tract was performed to verify the distinct site of melanoma. The tumor was stage IB1 according to the International Federation of Gynecology and Obstetrics classification.The patient underwent radical Wertheim–Meigs hysterectomy, bilateral salpingo-oopherectomy, and retroperitoneal pelvic lympadenectomy. Radiotherapy or chemotherapy was not performed in the postoperative period. She is now free of the disease 10 months after the operation. Primary malignant melanoma of the cervix is a rare cervical malignancy.

Primary malignant melanoma of the cervix, a rare neoplasm occurs in a wide age range, from 19–83 years [1]. Of these only about 9–13 % involve the cervix, rest of them involve the vulva and vagina [2]. Vaginal bleeding or discharge is the commonest mode of presentation. Cervical melanoma is thought to arise from the melanocytic cells of the cervix. Occasional tumors are detected during routine clinical examination by a cervical smear or the discovery of a distant metastasis [2]. The tumors are usually polypoid and red, brown, gray, black, or blue. Frequently, they are ulcerated. About 25 % of cases are amelanotic. We present a rare case of primary malignant melanoma arising in the cervix.

Cervical melanoma is a rare neoplasm and is seldom diagnosed by cervical scrape cytology. The possibility of metastatic melanoma should be excluded before making a diagnosis of primary cervical melanoma. We present a case of primary cervical melanoma diagnosed by cervical scrape cytology and a review of literature. The patient presented with vaginal bleeding of 3 mo duration and an ulcerated cervical growth. Cervical smear showed bizarre and abnormal cells containing pigment.

✓ Primary intramedullary melanoma is a very rare tumor that occurs most frequently in the middle or lower thoracic spinal cord. The authors present a case of primary cervical cord melanoma that developed in a 62-year-old man who was surgically treated and subsequently underwent radiation therapy. Clinical and histogenetic features of this neoplasm and results of chemo-, radio-, and immunotherapy are reported. Both “dysembryogenetic” and “mesodermal” hypotheses on the origin of primary spinal melanoma are discussed.

Primary malignant melanoma of uterine cervix is a rare and aggressive neoplasm. In women, genital tract is the site of approximately 3%-7%of malignant melanomas. Majority of these occur in vulva or vagina, but cervix is a rare site. Cervical melanoma is reported in the age range of 19 to 83 years with peak incidence between 60 to 70years. Malignant melanoma presents with vaginal bleeding or discharge and appears as exophytic, polypoid, pigmented or colorless cervical mass. Diagnosis is by histopathology which should be confirmed by immunohistochemical staining with S100 protein and HMB45. Primary cervical melanoma must be differentiated from secondary metastasis of melanoma to the cervix from other sites in the body. In general, prognosis of primary cervical melanoma is poor, because it is diagnosed at an advanced stage. No consensus has been established regarding treatment of primary malignant melanoma of cervix, because of its rarity. Cervical melanoma is incurable in totality with the currently available therapies and hence it has to be diagnosed early. A 60 year old woman presented with white discharge per vagina. On examination, there was a bluish black colored mass arising from the anterior lip of cervix. Following histopathology and other investigations, a diagnosis of primary malignant melanoma of uterine cervix was made. The case is reported for its rarity.

Introduction/Background: The incidence of cutaneous melanoma continues to rise rapidly. Approximately one quarter of all cases occur within the head and neck region1. The primary management of melanoma is surgical extirpation, regardless of size. Large, destructive lesions often are associated with significant morbidity. There is a role for surgery in the palliative setting in order to decrease morbidity and assist in symptom relief for selected patients2. This case report describes the management of a massive, locally-recurrent melanoma significantly impacting quality of life.

Primary malignant cervical melanoma is diagnosed by the presence of junctional melanocytic abnormality and the absence of distant metastasis. Amelanotic and poorly differentiated tumors can often be diagnosed with the HMB-45 immunoperoxidase stain which is very specific for melanoma. Early reported cases were treated with simple excision followed many times by radiation therapy. Radical hysterectomy, pelvic lymphadenectomy, and partial vaginectomy have been advocated by some contemporary investigators. Radiation can be used as adjuvant or palliative treatment; its efficacy is not well established. Few patients have been treated with modern chemotherapy. No patient has been treated with immunotherapy. Primary malignant cervical melanoma carries a very poor prognosis. Most patients succumb from their disease within 2 years. One patient has survived 14 years. The small number of reported cases makes it difficult to evaluate the efficacy of any treatment modality.

Objective: To present a case of malignant melanoma of the uterine cervix and review the medical literature, evaluate the clinical presentations and prognosis, and establish a plan of management for this rare pathology.Methods: A case of cervical malignant melanoma treated at our institution was prospectively followed until her death. An extensive MEDLINE search was then performed to obtain all previous case reports on this entity. Information regarding age, clinical presentation, staging, pathology, lymphnode status, treatment, and survival was reviewed.Results: Our patient is a 70-year old white female who presented with a 4-month history of irregular vaginal bleeding. She was diagnosed with malignant melanoma of the cervix, stage IIa, for which she underwent a modified radical hysterectomy, partial vaginectomy, and pelvic and para-aortic lymph node dissection. She received adjuvant radiation therapy to the pelvis, total dose of 4500 cGy. The patient's survival was 29 months. There have been only 24 published cases of primary cervical melanoma in the medical literature. The patients' ages ranged from 39 to 78 years old. The main presenting symptom was vaginal bleeding (67%). The majority of the patients, 58%, presented in early stages (Ia to IIa). Treatment was varied, ranging from a simple excision of a mass to radical hysterectomy with lymph node dissection and adjuvant radiation or chemotherapy. Survival was widespread, even within the same stage.Conclusion: Cervical melanoma is a rare disease of which no prospective or retrospective studies exist, only case reports. Treatment controversies exist. We recommend radical surgical excision to obtain negative margins and lymphadenectomy only for grossly positive nodes. The prognosis is poor and unpredictable.

Nine cases of malignant melanoma of the female genital tract were diagnosed 1n the Department of Pathology. University of Hong Kong, from 1978-88. Five cases involved the vagina, two the uterine cervix, one the cervix and vagina, and one the vulva. The primary origin was confirmed histologically 1n 5 cases - 2 vaginal, 2 cervical, and 1 vulval. This distribution contrasts with that 1n the literature where the vulva 1s the most frequently involved genital site, followed by the vagina, and then the cervix. All 5 proven primary melanomas were of the mucosal lentlglnous type. The clinical details were similar to that reported In the literature. The patients mean age was 60yrs, ranging from 37-80yrs, the majority were postmenopausal and the presenting symptoms were per vaginal bleeding or discharge 1n most cases. All cases, except that of an amelanottc melanoma, showed advanced disease at the time of diagnosis with invasion near to 3mm depth by Breslow’s method. This was reflected in the poor prognosis of all our cases. Six of the nine died of the disease within a period of 2-24 months. The three surviving were diagnosed at clinical Stage I and II (FIGO) and have a median survival of 18 months. Pregnancy may have contributed to earlier detection of cervical melanoma in one case. Our observations conform with others who found FIGO clinical stage and Breslow’s tumor thickness to be good prognostic indicators.

Objective To report our experience using ipilimumab, a monoclonal antibody targeting CTLA-4, combined with radiation therapy in women diagnosed with mucosal melanoma of the lower genital tract. Methods We retrospectively identified all patients who received ipilimumab with concurrent radiation treatment of mucosal melanoma of the lower genital tract at Memorial Sloan Kettering Cancer Center from 2012 to 2015. Various clinicopathologic data and treatment response were abstracted and analyzed. Results Four patients were identified. Median age was 61.5 years (range 44–68); 3 were diagnosed with vaginal melanoma, 1 with cervical melanoma. All would have required extensive surgical procedures to remove entirety of disease. Median size of lesions was 4.7 cm (range, 3.3–5.3); all were Ballantyne stage I. Median number of doses of upfront ipilimumab was 4 (range, 3–4). Two patients suffered CTCAE grade 3 adverse events (colitis, rash). All received external beam radiation: 3 to 3000 cGy, 1 to 6020 cGy. Post-radiation surgical resection was performed in 3 patients (75%); 1 (33%) of 3 patients achieved complete pathologic response. Complete local radiographic response was observed in all patients after completion of initial therapy and surgery. Two developed recurrence at 9 and 10 months post-diagnosis (mediastinum, lung); 2 remain disease-free at 20 and 38 months. Conclusions Mucosal melanoma of the lower genital tract is rare, and data-driven treatment strategies limited. Immunotherapy has demonstrated durable efficacy in the treatment of cutaneous melanomas. Our small case series shows a favorable response to combined ipilimumab and radiation therapy. Larger studies are needed to validate these promising results., Highlights • Mucosal melanoma of the lower genital tract is rare, and data-driven treatment strategies limited. • Our small case series shows a favorable response to combined ipilimumab and radiation therapy. • Larger studies are needed to validate these promising results.