Vulvar melanoma: A rare case report from the department of obstetrics and gynecology

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Introduction: Approximately 3% to 5% of all cancer cases in women are caused by vulvar cancer, a rare tumor compared to other gynecological tumors. It is a particularly aggressive tumor originating from melanocytes and accounts for only 2.9% of all vulvar malignancies. Case Report: A 56-year-old woman, single, menopausal for five years, presented with chronic left-sided vulvar pruritus evolving for approximately five years. Gynecological examination revealed a large erythematous lesion involving both labia majora, with a central erosive area and peripheral induration, associated with an irregular pigmented plaque centered on the left labium majus, extending posteriorly to the perineum and to the inner surface of the buttocks. Multiple excoriations due to scratching were noted, as well as several nevi, with no palpable inguinal lymphadenopathy. Bilateral inguinal ultrasound demonstrated lymphadenopathies of variable sizes, including nodes showing loss of fatty hilum, the largest measuring 10 × 9.4 mm on the left and 7 × 6 mm on the right, without abnormal fluid collection. Pelvic magnetic resonance imaging (MRI) revealed a vulvar tissue process located in the posterior aspect of the left labium majus, without signs of deep extension. Thoraco-abdomino-pelvic computed tomography (CT) showed no evidence of metastatic disease. The patient underwent partial vulvectomy combined with bilateral inguinal lymph node dissection followed by reconstruction using a flap procedure. Surgical margins were clear on frozen section. Final histopathological examination confirmed an invasive superficial spreading vulvar melanoma, associated with an extensive in situ component. Breslow thickness was 1 mm, with invasion limited to the superficial dermis (Chung level I). Mitotic activity was 6 mitoses per 10 high-power fields, with no ulceration, no lymphovascular invasion, and no perineural invasion. The invasive component was located more than 10 mm from all surgical margins; however, the in situ component involved the external and internal margins and was 6 mm from the superior margin. Bilateral inguinal lymph node dissection showed no metastatic involvement. Conclusion: Vulvar melanoma is a rare and particularly aggressive tumor with a poor prognosis. Prognostic factors include tumor size, depth of invasion, tumor differentiation, surgical margins, patient age, involvement of adjacent structures, and especially lymph node status.

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