Primary Mucosal Melanoma of the Vagina: About a Case Treated
by External Beam Radiotherapy and High-Dose-Rate Brachytherapy
Abdelhamid El Omrani
Received: 14 March 2018 / Revised: 10 April 2018 / Accepted: 13 April 2018 / Published online: 19 April 2018
Ó Association of Gynecologic Oncologists of India 2018
Background Vaginal melanoma is an extremely rare entity. It is an aggressive disease with a poor prognosis and short-term
survival related to high rate of local and distant recurrences. Treatment modalities are not codiﬁed and include surgery,
radiotherapy and chemotherapy. Radiotherapy is always used as adjuvant treatment after wide local excision, but there are
little data about its use as an exclusive treatment or after partial surgery.
Case We report the case of vaginal melanoma in 31-year-old Arabic woman. The patient refused radical surgery, and
partial surgery was performed followed by hypofractionated external beam radiotherapy at the dose of 20 Gy in 5 daily
fractions of 5 Gy week (biologic effective dose = 53.33 Gy for melanoma a/b = 3), to the entire pelvis including inguinal
lymph nodes; then, the tumor bed was boosted by high-dose-rate brachytherapy at the dose of 28 Gy in 4 fractions of 7 Gy.
After 12 months of follow-up, the patient is free of local or distant recurrence.
Conclusion Radiotherapy is an effective therapeutic modality of vaginal melanoma, especially when radical surgery is not
feasible or refused. Radiation oncologist must integrate radio-biologic characteristics of melanoma in the choice of dose
Keywords Vaginal melanoma Á Surgery Á High-dose radiotherapy Á Radiobiology
Vagina is a rare localization of melanoma, accounting for
0.3–1% of malignant melanoma and 3% of all vaginal
tumors. It typically affects women in their sixth and sev-
enth decades . Melanocytes are the presumed precursors
of vaginal melanoma; it can be found in the basal portion
of the vaginal epidermis in 3% of normal adult females .
Vaginal discharge, genital bleeding and a vaginal mass are
the most frequent symptoms. Treatment modalities are
varied and include, individually or in combination, con-
servative or radical surgery, radiotherapy and chemother-
apy [3, 4]. Vaginal melanoma has a poor prognosis; the
5-year overall survival is under 20% from literature data.
We report a case of malignant primitive vaginal melanoma
and discuss the clinical features and available treatments of
this uncommon disease, with focus on the role of radio-
therapy and radio-biologic characteristics justifying the use
of high-level doses.
A 31-year-old Arabic woman, without personal medical
history, presented with foul-smelling discharge and genital
bleeding since 6 months, without pelvic pain, rectal
bleeding or urinary symptoms. Physical examination
showed a healthy patient with a WHO performance status
to 1; gynecological examination discovered a 1-cm dark
nodular tumor of the posterior wall of vagina, in the distal
one-third. There were no inguinal lymph nodes, and the
body skin examination was normal. A biopsy was per-
formed which showed a tumor proliferation of big and
& Sana Zabroug
Department of Radiotherapy, Mohammed VI Oncology-
Hematology Center, Marrakesh, Morocco
Faculty of Medicine and Pharmacy, Cady Ayyad University,
Indian Journal of Gynecologic Oncology (2018) 16:28