Vulvar or vaginal melanoma is a rare form of gynaecological cancer with not a great deal of research on best treatment methods. One important consideration is keeping vulvar tissue intact, because disfigurement, pain and complications can appear with surgical interventions. Vulvar and vaginal cancers are rare, making up two to three per cent of all gynaecological malignancies.

Melanoma is the third most common for of vulvar cancer, comprising between four and 10 per cent, and the second most common malignant cancer after squamous cell carcinoma. Vulvar or vaginal melanoma occurs in about 0.2 out of every 100,000 women, with Caucasian women more often affected. Typically diagnosis is later in life, after age 50, but it can occur at any age.

The labia minora and majora are the most commonly affected areas, with the clitoris involved in some studies.

One of the issues with vulvar or vaginal cancers is the late stage of diagnosis when disease is quite advanced. Survival rates are therefore low compared with other forms of cancer.

Symptoms of vulvar or vaginal melanoma

• Vaginal or vulvar lesions
• Pigmented lesions on the vaginal mucosa or vulva (macules, patches, nodules)
• May be ulcerated
• May be more than one lesion

Diagnosis of vulvar or vaginal melanoma

These types of cancer may be discovered during a routine examination, as they produce few noticeable symptoms and the vulva is an area that most women may never see properly. Survival rates increase the younger the patient is (68 years and younger tend to do the best).

Treatment for vulvar or vaginal melanoma

Surgery is the main treatment method, with a dearth of topical treatments available. Imiquimod cream has been useful in other types of melanoma, with excellent cure rates, but is not often used in vaginal/vulvar melanoma. Imiquimod can be used once weekly for a month, then twice weekly the second month, then three times the third and fourth months.

Imiquimod is an immune stimulant that triggers the body to produce cytokines to fight viruses and cancer cells, with upregulation of antiviral and antitumour activities. Cytokines cause inflammation, and it’s this inflammation that kills the cancer cells. Side effects may include flu-like symptoms: fever, fatigue, headache, nausea, diarrhoea, muscle pain. These tend to be mild and resolve at cessation of treatment. Imiquimod is used to treat genital warts, and has been effective at treating vulvar intraepithelial neoplasia (VIN). Imiquimod reduces lesion size and can clear the HPV virus after 16 weeks of treatment for genital warts.

Chemotherapy, radiotherapy, and immunotherapy may also be used together or separately to treat vulvar or vaginal melanoma.