EC GYNAECOLOGY Case Report Post-Menopausal Bleeding: A Case of Vaginal Malignant Melanoma

A 68 year old postmenopausal lady was referred for vaginoscopy of a vaginal lesion. The lesions were violaceous in colour, maculopapular and friable with a maximum diameter of 20 mm. Histological biopsy showed malignant melanoma cells with strongly positive Melanin A staining and brisk mitotic activity. Cells with prominent red nucleoli with eosinophilic cytoplasm were noted. A radical vulvectomy was performed 2 weeks after the initial diagnosis and the patient recovered well. Tumour histology showed a completely resected multifocal melanoma in situ with minimal focal microinvasion. The tumour was clear of all excision margins. Discussion: 2% of the female genital tract malignancies are accounted for by vaginal carcinomas. Malignant melanoma accounts for 10% of such cases, with only 250 cases being described. White women have a higher incidence of such malignancy. Conservative local excisions give a comparable survival rate, comparing well with radical pelvic exenteration combined with local radiotherapy. 5-year survival is 10%. Lesions are usually papular to nodular. Tumour size is the most reliable predictor of survival with the tumour thickness being a poor predictor of survival. A differential diagnosis of vaginal secondary metastasis must be excluded by a proper examination, including vaginoscopy. Conclusion: Vaginal malignant melanoma has an overall poor survival rate with a 5 25% 5-year survival rate due to its late diagnosis. Early diagnosis and awareness may aid survival.