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Abstract
Introduction. Vulvovaginal melanoma is a rare disease for which no uniform diagnostic or treatment standards exist. This, along with the absence of specific clinical guidelines, underscores the importance of analyzing prognostic factors and oncological outcomes in this patient population to enable treatment individualization.
Aim. To identify prognostic factors and evaluate long-term outcomes in patients with vulvar and vaginal melanoma after surgical treatment.
Materials and Methods. A single-center retrospective cohort study was conducted, including patients with vulvar or vaginal melanoma who underwent surgical treatment at the N.N. Blokhin National Medical Research Center of Oncology between 2019 and 2025. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and local recurrence rates were assessed. Clinico-morphological and molecular-genetic tumor characteristics were analyzed in relation to long-term treatment outcomes.
Results. A total of 47 patients were included. The one-year OS rate was 91.7 %; the three- and five-year OS rates were identical at 68.2 %; median OS was not reached. The one-year DFS rate was 56.2 %; the three- and five-year DFS rates were 32.4 and 19.5 %, respectively; median DFS was 19 months. The three-year OS rates after wide local excision of vulvar or vaginal melanoma and after vulvectomy were 83.6 and 41.7%, respectively, with corresponding three-year DFS rates of 36.1 and 18.5 %. The overall local recurrence rate was 38.5 %. Factors significantly associated with worse prognosis were Breslow thickness ≥ 3 mm, lymphovascular invasion, and peritumoral lymphoid infiltration.
Conclusion. Surgical treatment remains the main therapeutic approach for patients with vulvovaginal melanomas. Wide local excision may be considered the preferred surgical approach given its comparable oncologic outcomes relative to vulvectomy. Nevertheless, the high recurrence rate underscores the need for personalized treatment strategies and further research.
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