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Vanessa Olival 1; André Correia, 1; A. Gomes, 2; Ana Francisca 2

1- Centro Hospitalar de Lisboa Central, Hospital de Dona Estefânia
2- Instituto Português de Oncologia de Lisboa, Francisco Gentil
Lisbon, Portugal

Congresso Internacional de Ginecologia Oncologica,  Liverpool 2013

Objectives: Vulvar melanoma is the second most frequent vulvar neoplasm although it accounts for only 3-5% of female melanoma. These are more frequent in post menopausal women, in their 6th decade of life, over the labia minora or clítoris and possibly extending to the urethra or vagina. Usually being asymptomatic, the diagnosis is based on inspection when an hyperpigmented and exophytic lesion is found. However, genital pruritus, haemorrahge or enlarged inguinal nodes may be noted.
The prognosis depends on the lesion size and its depth (better when <1mm); ulceration, melanosis and advanced age usually indicate poor prognosis.
Material and Methods: A 73 year-old female bedridden patient was referred for large hyperpigmented vulvar lesion, with palpable inguinal lymph nodes.
Results: An incisional biopsy was performed and confirmed the clinical diagnosis of melanoma; the sentinel lymph node biopsy was equally positive. Radical vulvectomy along with an extended bilateral inguinal lymphadenectomy was performed. The vulvar reconstruction  took place immediately after ablative surgery. 9 months later the patient was referred to the Palliative Care Unit
Conclusion: Although rare, vulvar melanoma is highly lethal, offering a 22-54% 5-year survival rate. Differential diagnosis include seborrheic keratosis, nevocellular nevus nad lentigus. The mainstay of treatment is now the excision with surgical margins of 1 to 3cm, being the existence of palpable enlarged lymph nodes an indication for radical vulvectomy. Sentinel lymph node biopsy offers relevant prognosis related information. This case-report shows the importance of pelvic examination of dependent or bedridden elderly women, as vulvar tumors may grow into large masses on account of their incapacity of performing an early, self-diagnosis.