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5 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Vulvar melanoma is the second most common vulvar cancer, a melanoma of the mucosal skin of the vulva in older women that is usually found late and has shorter survival than skin melanoma. It is removed with a margin, staged like skin melanoma by thickness, and treated when advanced with the immunotherapy and, for the quarter with a BRAF or KIT mutation, the targeted drugs used for other melanomas.
Primary vulvar melanoma is the second most common vulvar malignancy and is staged by the American Joint Committee on Cancer system for cutaneous melanoma despite its distinct site and genetics; in 100 patients, older age, greater thickness, higher dermal mitotic rate, ulceration, lymphovascular and perineural invasion, microscopic satellitosis and absence of a precursor naevus were associated with worse survival, and thickness and mitotic rate robustly predicted melanoma-specific survival (Clin Cancer Res 2017). A review of 33 patients found the expected profile of older women with delayed presentation, high stage and shorter survival, lichen sclerosus in 9.1 percent, and c-KIT expression as a prognostic marker (Int J Mol Med 2014). Molecular profiling of 51 vulvar and vaginal melanomas against 2,253 non-gynaecological melanomas found BRAF the most frequently mutated gene (26 percent, against 8.3 percent of other mucosal melanomas), with fewer of the BRAF mutations at the valine 600 codon (Cancer 2017). Incidence differs less by race than cutaneous melanoma, with a white to black ratio of 3.14 to 1 for vulvar melanoma (Melanoma Research 2010).
How it differs from its parent: it is not a carcinoma, so HPV, p16 and the squamous pathways do not apply; staging follows melanoma thickness rather than FIGO; and systemic therapy follows the mucosal melanoma page.
| Setting | Approach | Guideline |
|---|---|---|
| All stages | Wide local excision by thickness with sentinel node biopsy; systemic therapy as on the mucosal melanoma page: checkpoint inhibitors, BRAF and MEK inhibitors for BRAF V600, imatinib for KIT. | not mapped |