Rare disease: Vulval and vaginal melanoma

Vulval and vaginal melanoma are types of cancer that originate in the melanocytes, the pigment-producing cells of the skin of the vulva or vagina. Melanoma is more commonly associated with the “normal” skin, but it can also develop in areas that are commonly not exposed to sun such as the vulva, or mucosal surfaces, including the vagina (also called mucosal melanomas). The cause of these cancers are poorly understood.

Melanomas in the vulva or vagina are not related to sun exposure, as is often the case with melanomas on sun exposed areas of the body. Vulval and vaginal melanomas are rare, accounting for a small percentage of all melanomas. Vulval melanoma makes up between 2% and 4% of vulvar cancers (only about 10 women per year in Australia are diagnosed). They typically occur in postmenopausal women.

Vulval Melanoma

  • Location: Vulval melanoma arises on the external genitalia of women, which includes the labia majora and minora, clitoris, and perineum. Sometimes these tumours can be seen on self-examination.
  • Symptoms may include changes in the colour, size, or shape of existing moles or the appearance of new pigmented lesions. Itching, pain, bleeding, or an ulceration on the vulva may also occur.
  • Diagnosis is typically confirmed through a biopsy, where a small sample of tissue is examined under a microscope to identify cancer cells.
  • Treatment options include surgery to remove the tumour, and depending on the stage lymph node dissection, radiation therapy, and, in some cases, immunotherapy or targeted therapy for advanced disease. Depending on its location, patients may benefit from a removal of groin lymph nodes or at least monitoring of those.
  • Unfortunately, melanomas on the vulva and vagina can be aggressive and fast growing.

Vaginal Melanoma

  • Vaginal melanoma develop even rarer than vulvar melanomas.
  • Location: Vaginal melanoma develops in the lining of the vagina. They are hardly ever visible through self-examination.
  • Symptoms: Symptoms may include abnormal vaginal bleeding, pain during intercourse, and changes in the colour or appearance of the vaginal tissue.
  • Diagnosis: Like vulval melanoma, the diagnosis is typically confirmed through a gynaecological examination and a biopsy.
  • Treatment: Treatment options may include surgery to remove the tumour, radiation therapy, and in some advanced cases, chemotherapy or immunotherapy.

Both vulval and vaginal melanomas are often diagnosed at an advanced stage, partly due to the fact that symptoms may not be noticeable in the early stages. Early detection is crucial for improved outcomes, so any unusual symptoms in the genital area should prompt a visit to the GP in the first instance.

Being diagnosed with an aggressive, rare cancer can be a distressing process—speaking to a gynaecological oncologist will help you to be informed on how to effectively treat the disease.

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