A Rare Case Report: Malignant Vulvar Melanoma

Cancer of the vulva is not a common disease. It accounts for approximately 4% of cancers in the female reproductive organs and 0.6% of all cancers in women. Malignant melanomas of the vulva are rare tumors located in areas of the body not exposed to ultraviolet radiation. Although vulvar melanomas account for less than 1% of all melanomas, they are the second most common type of vulvar malignancy accounting for around 10% of all malignant tumors involving the vulva. Presentation is typically a decade later than cutaneous melanoma with a tendency to late metastases and poorer prognosis. Given their rarity, the treatment paradigm is less clearly defined and largely extrapolated from that of cutaneous melanomas. A case of Mrs. Y, 70 years old, P3L1 presented with complaints of swelling in the labial region for two and a half months, associated with severe itching, was reported. She also had C/O white discharge PV for 2 months, which was non-foul smelling and not blood-stained; on examination, her abdomen was soft and non-tender. A local examination found 2 × 3 cm growth arising from labia minora, irregular surface, and hyperpigmented lesion with white patches and ulcerated surface. Left inguinal lymph nodes were palpable. Per speculum examination revealed pigmented lesions over the anterior vaginal wall, anterior and posterior lip of cervix, cervix and vagina healthy. Excisional biopsy, fractional curettage, and FNAC were done. Histopathology of the specimen showed the diagnosis of nodular melanoma (tumorigenic melanoma), Clark’s level IV. Cervical biopsy showed the features of chronic cervicitis. FNAC showed the features of metastatic malignant melanoma.