Malignant gynecologic melanoma is a rare but highly aggressive malignancy that occurs primarily in the female reproductive organs in melanocytes. Although this type of tumor is relatively rare in gynecological tumors, its high recurrence rate and high mortality rate make early diagnosis and effective treatment particularly important. This article will introduce the definition, clinical signs and treatment of gynecological malignant melanoma.
Malignant melanoma is a malignant tumor derived from melanocytes, which are responsible for pigment production in the skin and other tissues. Malignant gynecological melanoma often occurs in the vulva, vagina and cervix of women. Although melanoma of the vulva is the most common type, melanoma of the vagina and cervix have also been reported.
clinical signs
The clinical signs of
malignant gynecologic melanoma are diverse and symptoms are often nonspecific, making early diagnosis challenging. Here are some common clinical signs:
1. Vulvar melanoma
• Lesion appearance: Vulvar melanomas often appear as black or brown, irregularly shaped, pigmented lesions. The boundary is blurred.
• Ulceration and bleeding: Ulceration, bleeding, or pain may occur in the diseased area.
• Itching and burning: Patients may experience localized itching or burning.
2. Melanoma
of the vagina and cervix
• Abnormal bleeding: Melanoma of the vagina or cervix often presents with abnormal vaginal bleeding, especially after sexual intercourse.
• Vaginal secretion: Abnormal vaginal secretion, which may be accompanied by odor.
• Pain: Pelvic pain or pain during intercourse.
Because these symptoms are similar to other gynecological diseases, such as infections or benign tumors, the diagnosis depends on a detailed history, physical examination and auxiliary examinations.
Diagnostic method
The diagnosis
of gynecological malignant melanoma needs to consider the results of clinical signs, imaging examination and pathological examination. Here are some common diagnostic methods:
1. Physical examination
The physician examines lesions of the vulva, vagina, and cervix by inspection and palpation.
2. Imaging examination
• Ultrasonography: used to assess the size and location of tumors in the pelvic cavity.
• Magnetic resonance imaging (MRI): provides more detailed imaging of soft tissue and helps to assess the extent of tumor invasion.
• Computed tomography (CT): used to assess the metastasis of the tumor.
3. Pathological examination
• Biopsy: Pathological examination is the gold standard for the diagnosis of malignant melanoma by obtaining a tissue sample of the lesion.
• Immunohistochemical staining: used to identify characteristic markers of melanoma such as S-100 protein, HMB-45, and Melan-A.
Treatment
The treatment
of gynecological malignant melanoma requires an individualized plan, which usually includes surgery, radiotherapy, chemotherapy and immunotherapy. Here are some of the main treatments:
1. Surgical treatment
Surgical resection is the first choice
for gynecological malignant melanoma, especially for early stage tumors. The extent of surgery depends on the size and extent of the tumor, and may include vulvectomy, vaginectomy, or trachelectomy.
2. Radiotherapy
For postoperative adjuvant therapy or inoperable advanced tumors, radiotherapy can be used. Radiotherapy can reduce the risk of local recurrence and improve the survival rate.
3.Chemotherapy
Chemotherapy is usually used for advanced or metastatic melanoma. Commonly used chemotherapy drugs include dacarbazine, cisplatin and paclitaxel. However, gynecological malignant melanoma has low sensitivity to chemotherapy and limited efficacy.
4. Immunotherapy
In recent years, significant progress has been made in the immunotherapy of melanoma, especially in the treatment of PD-1/PD-L1 inhibitors.
5. Targeted therapy
For patients with BRAF mutations, BRAF inhibitors (such as vemurafenib) and MEK inhibitors (such as trametinib) can be used as treatment options.
Gynecological malignant melanoma is a rare but highly aggressive tumor. Early diagnosis and individualized treatment are the key to improve the survival rate of patients. Women should pay attention to regular gynecological examination, timely detection and treatment of abnormal lesions. Through the comprehensive use of surgery, radiotherapy, chemotherapy, immunotherapy and other means, the prognosis of patients can be effectively improved.
References
1.Balch, C. M.,Gershenwald, J. E., Soong, S. J., et al. (2009). Final Version of 2009 AJCC Melanoma Staging and Classification. Journal of Clinical Oncology, 27(36), 6199-6206. 2.National Comprehensive Cancer Network. (2021). NCCN Clinical Practice Guidelines in Oncology: Melanoma. Retrieved fromhttps://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf 3.American Cancer Society. (2021). Melanoma Skin Cancer. Retrieved fromhttps://www.cancer.org/cancer/melanoma-skin-cancer.html Malignant melanoma
