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Vaginal melanoma is a very rare, aggressive melanoma of the vaginal lining in older women, usually found late because it is hidden, with the worst outlook of any melanoma site. It is treated with surgery where the tumour can be removed and radiotherapy where it cannot; advanced disease gets the drugs used for mucosal melanoma. Unlike skin melanoma it is as common in black as in white women.
Vaginal melanoma is a mucosal melanoma listed among the vaginal tumours in the WHO female genital classification and among the vaginal cancer page's types. In SEER data for 1992 to 2005, 125 vaginal melanomas were recorded against 324 vulvar, with age-adjusted incidence of vulvar and vaginal melanoma per million women of 0.87 in black, 0.75 in American Indian, 1.03 in Asian and Pacific Islander, 1.22 in Hispanic and 1.90 in non-Hispanic white women, and a vaginal white to black ratio of 1.02 to 1 (Melanoma Research 2010). Molecular profiling of 14 vaginal and 37 vulvar melanomas found BRAF mutations in 26 percent of vulvovaginal melanomas, more than in other mucosal melanomas, and other targetable alterations (Cancer 2017).
How it differs from its parent: it is not an HPV-associated carcinoma, so the vaginal cancer page's squamous and adenocarcinoma pathways do not apply; it presents with bleeding or a mass in the lower third of the vagina, spreads early to nodes, lung and liver, and has a five-year survival below that of vulvar melanoma in the literature the sources cite.
How common: under 1 per million women a year, with no racial gradient (Melanoma Research 2010).
Treatment: wide local excision or, for larger tumours, radical surgery where organ function allows, with radiotherapy as an alternative or adjunct; sentinel node assessment; systemic therapy as on the mucosal melanoma page (checkpoint inhibitors, BRAF and MEK inhibitors for BRAF V600, imatinib for KIT), with trials recommended (Cancer 2017).
Very rare: 125 vaginal melanomas were diagnosed in the US SEER registries over 1992 to 2005, with a white to black incidence ratio of 1.02 to 1, far below the 13 to 17 to 1 of cutaneous melanoma (Melanoma Research 2010).
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Excision or radical surgery where feasible, radiotherapy as an alternative or adjunct; systemic therapy as on the mucosal melanoma page; trials recommended.
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Query for this cancer: (TITLE:"Vaginal melanoma" OR ABSTRACT:"Vaginal melanoma" OR TITLE:"Primary vaginal melanoma" OR ABSTRACT:"Primary vaginal melanoma" OR TITLE:"Melanoma of the vagina" OR ABSTRACT:"Melanoma of the vagina" OR TITLE:"Vulvovaginal melanoma with vulvar melanoma" OR ABSTRACT:"Vulvovaginal melanoma with vulvar melanoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Vaginal melanoma, not a curated reading list.
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Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Take with a meal and a large glass of water.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:ImatinibNivolumabPembrolizumab·Printable cards in the navigator
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