Primary Malignant Melanoma Of The Vagina:a Retrospective Clinico-Pathological Study Of Forty-four Cases

Objective:Primary malignant melanoma of the vagina is an extremely rare, but highlyaggressive tumor, with limited information regarding survival and prognostic factors. In order to identify prognostic predictors of survival and improve treatment selection, we performed this retrospective study.Materials and Methods:Between December2002and August2011, forty-four patients with histologically diagnosed PMMV in Fudan University Shanghai Cancer Center were evaluated retrospectively. Prognostic variables were analyzed by both Kaplan-Meier survival analysis and Cox proportional hazards regression.Results:The mean age of the patients was58.7years, and seventy-seven percent of patients were postmenopausal women. Of the44patients, forty-one were treated with surgery and3with radiochemotherapy only. The mean follow-up time was27.6months (range,3.0-94.3months). Thirty (68.2%) of the44patients developed recurrences, and21(47.7%) patients died of disease. The2-year progression-free survival rate and overall survival rate were38.4%and61.4%, respectively. The5-year progression-free survival rate and overall survival rate were18.3%and39.8%, respectively. Median progression-free survival time was14.4months (95%confidence interval [CI]:9.8-18.9months) and median overall survival time was39.5months (95%CI9.4-69.7months). On univariate analysis, depth of invasion was an important prognostic predictor for overall survival (P=0.004). And adjuvant therapy was statistically associatied wit progression-free survival (P=0.038). On multivariable analysis, depth of invasion was an independent prognostic predictor for overall survival (P=0.041) and tumor size and adjuvant therapy were independent prognostic predictor for PFS (P=0.003, P=0.005, respectively). Age, menopausal status, multifocal lesion, the extent of surgery, lymph node status and positive margin were all not statistically significant associated with PFS and OS, though lymph node status and positive margin may have some tendency, especially the lymph node status. And there was an obvious statistical association between depth of invasion and lymph node status (P=0.048).Conclusion:Primary malignant melanoma of the vagina is a rare, highly lethal disease. Optimal treatment should be considered as surgery in favor of local wide excision for suitable women. The prognosis is deeply influenced by tumor depth of invasion and lymph nodes involvement. Tumor size and adjuvant therapy was associated with progression-free survival.