POOR OUTCOME IN VAGINAL MELANOMA

NEW YORK (Reuters Health) Dec 13 - Malignant vaginal melanoma, even when localized at presentation, has a very poor prognosis with a 5-year survival of only 20%, researchers report in the December 6th issue of Obstetrics and Gynecology.

"We believe a multimodality approach to vaginal melanoma -- surgery, radiation, and immunotherapy -- makes sense," Dr. Michael Frumovitz told Reuters Health by email, "but a trial of that sort will be very difficult to do owing to the rarity of the disease."

To examine the current situation, Dr. Frumovitz and colleagues at The University of Texas MD Anderson Cancer Center retrospectively reviewed data on 37 women who were treated at that institution between 1980 and 2009.

Their median age was 60.6 years and vaginal bleeding was the most common presenting symptom. Most (65%) had lesions in the distal third of the vagina.

Radical or wide local excision was employed initially in 76% and 14% were scheduled for pelvic exenteration. The four women (10%) in whom surgery was considered unsuitable received radiotherapy, chemotherapy or both.

At a median follow-up 17.4 months, 33 women (89%) had recurrence. Recurrence was local only in seven patients, distant only in 20, and both in five.

Median progression-free survival was 11.4 months and median overall survival was 19.1 months.

Median survival was 34.4 months for women who underwent pelvic exenteration, not significantly different from the 24.3 months in the wide local or radical excision group. Median survival was 8.7 months in the non-surgical group.

The only pathologic finding that was significantly associated with survival was nodal status. Median survival was 7.8 months for patients with positive nodes and 30.0 months in those with negative nodes. However, the researchers observe that this is likely to be of prognostic significance only.

Because 93% of patients had recurrence after wide excision and adjuvant radiation therapy at one or more sites, the investigators suggest that systemic therapy with interferon-alpha might be a useful approach.

However, they conclude, "a clinical trial in this specific disease is unfortunately unlikely."

Obstet Gynecol. Posted December 2010. Abstract