TY - JOUR
T1 - Vulvar and vaginal melanoma
T2 - Case series and review of current management options including neoadjuvant chemotherapy
AU - Janco, Jo Marie Tran
AU - Markovic, Svetomir N.
AU - Weaver, Amy L.
AU - Cliby, William A.
PY - 2013/6/1
Y1 - 2013/6/1
N2 - Objective We report our experience with vulvar (Vu) and vaginal (Va) melanoma, with review of surgical and adjuvant therapy guidelines and description of our use of neoadjuvant therapy in selected cases. Methods We reviewed patients seen at Mayo Clinic for management of Vu or Va melanoma, January 1993-February 2012. Surgical treatment, pathologic and outcome data were abstracted. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and compared between subgroups using the log-rank test. Results 50 patients underwent surgery for primary or recurrent melanoma (Vu = 36, Va = 14). The 5-year OS rate was 30.9%, with median OS of 3.3 years. Adjuvant therapy was given to 30.6% of Vu cases with varying combinations of agents. Among Vu patients, after adjusting for node status and depth of invasion, adjuvant therapy was not associated with improved OS (p = 0.39) or RFS (p = 0.31). Preoperative chemotherapy was used in 2 Va cases. Despite temozolomide followed by exenteration for a 4 cm multi-focal lesion, one patient died within 3 months. The second patient, with a 2 cm vaginal lesion, demonstrated a partial response to carboplatin and paclitaxel (CP). After local excision and lymphadenectomy she received additional CP with bevacizumab and remains disease free at 5 years. CP with bevacizumab was also used in 1 Vu case with a solitary 5 cm midline lesion. She underwent vulvectomy after a partial response, received additional CP and bevacizumab postoperatively, and remains without disease at 2 years. Conclusion Preoperative chemotherapy with CP and bevacizumab may improve treatment outcomes, particularly for Va and large Vu lesions.
AB - Objective We report our experience with vulvar (Vu) and vaginal (Va) melanoma, with review of surgical and adjuvant therapy guidelines and description of our use of neoadjuvant therapy in selected cases. Methods We reviewed patients seen at Mayo Clinic for management of Vu or Va melanoma, January 1993-February 2012. Surgical treatment, pathologic and outcome data were abstracted. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and compared between subgroups using the log-rank test. Results 50 patients underwent surgery for primary or recurrent melanoma (Vu = 36, Va = 14). The 5-year OS rate was 30.9%, with median OS of 3.3 years. Adjuvant therapy was given to 30.6% of Vu cases with varying combinations of agents. Among Vu patients, after adjusting for node status and depth of invasion, adjuvant therapy was not associated with improved OS (p = 0.39) or RFS (p = 0.31). Preoperative chemotherapy was used in 2 Va cases. Despite temozolomide followed by exenteration for a 4 cm multi-focal lesion, one patient died within 3 months. The second patient, with a 2 cm vaginal lesion, demonstrated a partial response to carboplatin and paclitaxel (CP). After local excision and lymphadenectomy she received additional CP with bevacizumab and remains disease free at 5 years. CP with bevacizumab was also used in 1 Vu case with a solitary 5 cm midline lesion. She underwent vulvectomy after a partial response, received additional CP and bevacizumab postoperatively, and remains without disease at 2 years. Conclusion Preoperative chemotherapy with CP and bevacizumab may improve treatment outcomes, particularly for Va and large Vu lesions.
KW - Adjuvant
KW - Management
KW - Melanoma
KW - Neoadjuvant
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U2 - 10.1016/j.ygyno.2013.02.028
DO - 10.1016/j.ygyno.2013.02.028
M3 - Article
C2 - 23480869
AN - SCOPUS:84877579834
VL - 129
SP - 533
EP - 537
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 3
ER -