Vulva, vagina & female urethra
Melanocytic lesions

Topic Completed: 1 February 2015

Minor changes: 19 October 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Melanoma vulva "loattrfree full text"[sb]

Priya Nagarajan, M.D., Ph.D.
Page views in 2020: 1,691
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Cite this page: Nagarajan P. Melanoma. website. Accessed January 24th, 2021.
Definition / general
Clinical features
  • May be discovered during routine gynecologic examinations
  • Usually present as pigmented and sometimes nonpigmented lesions (macules, patches, nodules)
  • May be ulcerated
  • May present with multiple lesions (satellitosis)
  • Histologic examination is essential
  • Serum lactate dehydrogenase levels > 200 to 225 U/L are associated with poor survival
Radiology description
Radiology images

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CT scan, enlarged lymph node

Prognostic factors
  • Age: patients that are 68 years or younger at diagnosis have a better prognosis
  • Histologic parameters:
  • Stage:
    • Patients with localized disease (stage 0, I, II) have a better prognosis (Obstet Gynecol 2007;110:296)
    • Higher number of positive lymph nodes is associated with worse prognosis
  • Strong and diffuse c-kit expression may be associated with a worse prognosis (Int J Mol Med 2014;33:784)
Case reports
  • Surgical resection with adequate margins is the principal management
  • Radiation
  • Chemotherapy
  • Topical imiquimod therapy
Clinical images

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Nodule and ulcer

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Large friable, gray white growth

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Vulvar melanoma

Gross description
  • Preservation of specimen orientation is critical for thorough evaluation of peripheral and deep tissue margins
Microscopic (histologic) description
  • Vulvar melanomas are evaluated and staged similar to cutaneous melanomas
  • Most of the melanomas involving the cutaneous surface only are traditionally classified based on the histologic type (superficial spreading being the most common type at this site)
  • However, when mucosal surfaces are involved, classifying them as mucosal lentiginous type would be most appropriate
  • See CAP: Cancer Protocol Templates [Accessed 9 October 2017]
  • Following histologic parameters should be included in the report:
    • Histologic type
    • Clark (anatomic) level
    • Breslow thickness (primary tumor thickness, if completely mucosal)
    • Presence of radial or nontumorigenic growth phase
    • Presence of vertical or tumorigenic growth phase
    • Mitotic rate per millimeter squared
    • Presence of ulceration (the microscopic size of ulceration is often included)
      • Must exercise caution in resection specimens as the ulceration might represent prior biopsy site
    • Presence of regression (mention percentage of regression, is associated with a poor prognosis if > 75%)
    • Presence of lymphovascular space invasion (the use of MART1 / MelanA plus D2-40 or CD34 immunostains is more sensitive)
    • Presence of perineural invasion (size of nerves involved should be mentioned)
    • Presence of microscopic satellitosis
    • Presence of tumor infiltrating lymphocytes (presence or absence; brisk vs. nonbrisk)
    • Presence of associated melanocytic nevi
    • Predominant cytology of the tumor cells
    • Status of surgical margins (for in situ and invasive melanoma)
  • Sentinel lymph nodes:
    • Examination of several H&E sections cut at various depth into the paraffin block and the use of immunohistochemistry for melanocytic markers are routinely employed to detect single cell metastases
Microscopic (histologic) images

Contributed by Priya Nagarajan, M.D., Ph.D.

Melanoma in situ

Melanoma in situ vs. atypical melanocytic hyperplasia

Mostly in situ, minimal invasive component

Invasive and in situ melanoma

Polypoid melanoma: low to intermediate magnification

High magnification

Melanoma with ulceration

Heavily pigmented

Recurrence in subcutaneous fibroadipose tissue

Isolated nodal metastases



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Pleomorphic spindled to epitheloid cells

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Cells in sheets

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Positive stains
Negative stains
Molecular / cytogenetics description
Differential diagnosis
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