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Obstetrics and Gynecology Clinics of... Sep 2017Cutaneous vulvar neoplasms are commonly encountered at gynecology visits, with 2% of women having a benign vulvar melanocytic nevus and 10% to 12% of nevi being vulvar.... (Review)
Review
Cutaneous vulvar neoplasms are commonly encountered at gynecology visits, with 2% of women having a benign vulvar melanocytic nevus and 10% to 12% of nevi being vulvar. High-grade squamous intraepithelial lesions (vulvar intraepithelial neoplasia 2 or 3) occurs in 5 per 100,000 women, with increasing incidence in the past 30 years. The recognition of these lesions and differentiation between benign, premalignant, and malignant stages are crucial for adequate diagnosis, clinical monitoring, and treatment. The presentation, diagnosis, and management of benign and malignant vulvar proliferations are discussed with focus on practical aspects of clinical care.
Topics: Female; Humans; Precancerous Conditions; Vulva; Vulvar Neoplasms
PubMed: 28778635
DOI: 10.1016/j.ogc.2017.04.002 -
Journal Der Deutschen Dermatologischen... Dec 2019Vulvar cancer represents the fourth most common gynecologic malignancy and is often encountered by the general Dermatologist or Gynecologist. Dermatooncologists and... (Review)
Review
Vulvar cancer represents the fourth most common gynecologic malignancy and is often encountered by the general Dermatologist or Gynecologist. Dermatooncologists and Gynecologic Oncologists share expertise in this field and the diagnosis and treatment should ideally be interdisciplinary. All subtypes are typically seen in the later decades of life, although all histologic subtypes have been described in women younger than 30 years. The diagnosis is often delayed. Exact mapping of biopsies is of high importance, as the location and distance from the midline guides the surgical approach depending on the underlying histology. Squamous cell carcinoma accounts for more than 76 % of vulvar cancer with vulvar intraepithelial neoplasia being an important precursor. Basal cell carcinoma is the second most common vulvar malignancy. Melanoma accounts for 5.7 % of vulvar cancer and has a worse prognosis compared to cutaneous melanoma. Most of the trials on checkpoint inhibitors and targeted therapy have not excluded patients with vulvar melanoma and the preliminary evidence is reviewed in the manuscript. Surgery remains the primary treatment modality of locally resectable vulvar cancer. In view of the rarity, the procedure should be performed in dedicated cancer centers to achieve optimal disease control and maintain continence and sexual function whenever possible.
Topics: Adenocarcinoma; Biopsy; Carcinoma in Situ; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Carcinoma, Verrucous; Female; Humans; Melanoma; Vulva; Vulvar Neoplasms
PubMed: 31829526
DOI: 10.1111/ddg.13995 -
Seminars in Nuclear Medicine Nov 2017Accurate staging of many cancers with no clinical evidence of lymph node involvement is often a critical component of the management of such cancers and is generally and... (Review)
Review
Accurate staging of many cancers with no clinical evidence of lymph node involvement is often a critical component of the management of such cancers and is generally and historically accomplished by accurate pathological assessment of multiple nodes. Unfortunately, such assessment usually involves excision of the multiple nodes and can result in significant morbidities. Over the past half century, and particularly over the last quarter century, investigators have defined and refined the "sentinel lymph node(s)" concept and have developed and investigated sentinel lymph node biopsy (SLNB) procedures. Such procedures are designed to stage cancers primarily via assessment of the sentinel nodes of the cancers and to do so with limited risk of morbidities. For some cancers (e.g., breast, melanoma, head and neck, penile), there are SLNB procedures that are used routinely. For other cancers, there are SLNB procedures being investigated that will yet prove successful and practical or successful but not practical or neither practical nor successful. In this review, SLNB procedures for breast, melanoma (adult and pediatric), head-and-neck, gastrointestinal (gastric, esophageal, colon), genitourinary (penile, prostate), and gynecological (uterine, cervical, vulvar, ovarian) cancers are discussed, including results of significant clinical trials performed using such in the management of these various cancers.
Topics: Adult; Child; Female; Humans; Lymph Node Excision; Male; Neoplasm Staging; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 28969759
DOI: 10.1053/j.semnuclmed.2017.06.004 -
Skin Health and Disease Apr 2023Lichen sclerosus (LSc) is a chronic, inflammatory, destructive skin disease with a predilection for the genitalia (GLSc). An association with vulval (Vu) and penile (Pe)... (Review)
Review
BACKGROUND
Lichen sclerosus (LSc) is a chronic, inflammatory, destructive skin disease with a predilection for the genitalia (GLSc). An association with vulval (Vu) and penile (Pe) squamous carcinoma (SCC) is now well established but melanoma (MM) has only rarely been reported complicating GLSc.
METHODS
We have performed a systematic literature review of GLSc in patients with genital melanoma (GMM). Only articles that mentioned both GMM and LSc affecting either the penis or vulva were included.
RESULTS
Twelve studies with a total of 20 patients were included. Our review shows that an association of GLSc with GMM has been more frequently reported in women and female children than men viz, 17 cases compared with three. It is notable that five of the cases (27.8%) concerned female children aged under twelve.
DISCUSSION
These data suggest a rare association between GLSc and GMM. If proven, there arise intriguing questions about pathogenesis and consequences for counselling of patients and follow-up.
PubMed: 37013116
DOI: 10.1002/ski2.198 -
Journal of the American Academy of... Dec 2014Pigmented vulvar lesions are present in approximately 1 in 10 women and include melanocytic and nonmelanocytic proliferations. Vulvar nevi, melanosis, and melanoma are... (Review)
Review
Pigmented vulvar lesions are present in approximately 1 in 10 women and include melanocytic and nonmelanocytic proliferations. Vulvar nevi, melanosis, and melanoma are particularly challenging because of the similarity of their clinical and/or histopathological presentation. As a result, they are often difficult to diagnose, may result in patient and physician anxiety, and can lead to unneeded, potentially disfiguring surgical procedures. Because it is often detected late, vulvar melanoma carries a poor prognosis with associated significant morbidity and mortality, underscoring the importance of prompt recognition and treatment. In this review, we analyze the distinct epidemiologic, clinical, and histopathologic characteristics of vulvar nevi, melanosis, and melanoma, discuss treatment options, and propose a practical, systematic approach to facilitate formulation of a differential diagnosis and initiation of appropriate management.
Topics: Diagnosis, Differential; Female; Humans; Melanoma; Nevus, Pigmented; Skin Neoplasms; Vulvar Neoplasms
PubMed: 25267379
DOI: 10.1016/j.jaad.2014.08.019 -
Cancers Oct 2022Cutaneous melanoma is a relatively common neoplasm, with fairly well understood pathogenesis, risk factors, prognosis and therapeutic protocols. The incidence of this... (Review)
Review
Cutaneous melanoma is a relatively common neoplasm, with fairly well understood pathogenesis, risk factors, prognosis and therapeutic protocols. The incidence of this disease is increasing every year. The situation is different for rare malignancies such as vulvar melanomas and for the even rarer vaginal melanomas. The risk factors for vulvovaginal tumors are not fully understood. The basis of treatment in both cases is surgical resection; however, other types of treatments such as immunotherapy are available. This paper focuses on comparing the pathogenesis and risk factors associated with these neoplasms as well as the efficacy of two groups of drugs-anti-PD-L1 and anti-CTLA4 inhibitors-against both cutaneous melanoma and melanoma of the lower genital tract (vulva and vagina). In the case of cutaneous melanoma, the situation looks more optimistic than for vulvovaginal melanoma, which has a much worse prognosis and, as it turns out, shows a poorer response to immune therapy.
PubMed: 36291906
DOI: 10.3390/cancers14205123 -
Cancer Treatment Reviews Feb 2019Vulvar malignant melanoma (VMM) is a rare disease, accounting for 5% of all vulvar malignancies and is characterized by low survival and high recurrence rates. It is... (Review)
Review
Vulvar malignant melanoma (VMM) is a rare disease, accounting for 5% of all vulvar malignancies and is characterized by low survival and high recurrence rates. It is considered as a distinct entity of mucosal melanoma. Prognostic factors are higher age, advanced Breslow thickness, and lymph node involvement whilst central localization and ulceration status are still under debate. Surgery is the cornerstone for the treatment of primary VMM, however, it can be mutilating due to the anatomical location of the disease. Elective lymph node dissection is not part of standard care. The value of sentinel lymph node biopsy in VMM is still being studied. Radiation therapy and chemotherapy as adjuvant treatment do not benefit survival. Immunotherapy in cutaneous melanoma has shown promising results but clinical studies in VMM are scarce. In metastatic VMM, checkpoint inhibitors and in case of BRAF or KIT mutated metastatic VMM targeted therapy have shown clinical efficacy. In this review, we present an overview of clinical aspects, clinicopathological characteristics and its prognostic value and the latest view on (adjuvant) therapy and follow-up.
Topics: Female; Humans; Melanoma; Randomized Controlled Trials as Topic; Vulvar Neoplasms
PubMed: 30685613
DOI: 10.1016/j.ctrv.2018.12.005 -
Annals of Diagnostic Pathology Dec 2018The diagnosis of melanocytic tumors is notoriously difficult and represents one of the most challenging areas in surgical pathology associated with significant risk for... (Review)
Review
The diagnosis of melanocytic tumors is notoriously difficult and represents one of the most challenging areas in surgical pathology associated with significant risk for litigation. One reason is the wide morphologic spectrum of melanocytic tumors and the fact that many histological features are shared by both benign melanocytic nevi and melanoma. Awareness of the many morphologic variations and variants of nevi and melanoma, their clinical setting, immunohistochemical phenotype and genetic profile is necessary for the correct diagnosis. The article discusses the features of three variants of melanoma, desmoplastic, acral lentiginous and vulvar mucosal lentiginous melanoma, and their benign melanocytic mimics with emphasis on distinguishing features.
Topics: Diagnosis, Differential; Humans; Melanoma; Nevus, Pigmented; Skin Neoplasms
PubMed: 30312883
DOI: 10.1016/j.anndiagpath.2018.09.010 -
Journal of the American Academy of... Feb 2020
Topics: Administration, Topical; Age of Onset; Anti-Inflammatory Agents; Asymptomatic Diseases; Calcineurin Inhibitors; Child; Child, Preschool; Diagnosis, Differential; Disease Progression; Female; Glucocorticoids; Humans; Melanoma; Skin Neoplasms; Vulva; Vulvar Lichen Sclerosus; Vulvar Neoplasms
PubMed: 31712176
DOI: 10.1016/j.jaad.2019.11.012 -
Dermatology Reports Nov 2022Vulvar malignant melanoma (VMM) is uncommon and poses a significant management challenge. Here, we presented a case of VMM managed by surgery, chemoradiation, and...
Vulvar malignant melanoma (VMM) is uncommon and poses a significant management challenge. Here, we presented a case of VMM managed by surgery, chemoradiation, and planned for targeted therapy. A 70- year-old woman with underlying diabetes mellitus and hypertension presented with a black-colored exophytic growth around her left vulva for two months. Initial biopsy confirmed malignant melanoma with positive staining for S100, HMB 45, and Melan A. An imaging study showed that the disease was localized to the vulva. She underwent bilateral radical vulvectomy and bilateral inguinofemoral lymph node dissection followed by radiotherapy. She had a locoregional disease recurrence, which was subsequently managed by palliative perineal radiotherapy, chemotherapy, and planned for immunotherapy. Vulvar malignant melanoma is a rare and aggressive tumor, with a poor overall prognosis, and high recurrence rate. Adjuvant chemotherapy, radiotherapy, and immunotherapy may be beneficial for local recurrence and distant metastasis cases. Molecular Analysis has a potential role in targeted therapy to improve the survival and outcome of the patient.
PubMed: 36483218
DOI: 10.4081/dr.2022.9345