| Objective: Primary malignant melanoma of genital tract is rare with high malignancy,poor prognosis.The purpose of the article is to explore the clinical features、treatment and the prognosis,and then take a base for clinical treatment and diagnosis of primary genital malignant melanoma.Methods: The data of 26 patients with malignant melanoma of genital tract from 1958 to 2020 in the Fourth Hospital of Hebei University of Medicine were retrospectively analyzed,including primary malignant melanoma of vulva 11 cases,vagina 9 cases,cervix 5 cases,ovary 1 case.SPSS software was used to analyze average and median survival time of different treatments.COX regression analysis statistical methods were used to analyse 3-year sirvival and 5-year survival rate.Results:1.Age distribution of malignant melanoma of female genital tract26 patients with primary malignant melanoma of the genital tract included in this study were in the age range 33-69 years,with an average age of 54.9 years and a median age of 59 years.There were 18 premenopausal patients and 8 postmenopausal patients.There were 3 patients between 30-40 years old,4 patients between 40-50 years old,6 patients between 50-60 years old,and 12 patients between 60-70 years old.The age range of onset has the The largest proportion of patients between 60-70 years old occupied the largest,accounting for 46.1% of the total patients.The following was the patients between 50-60 years old(23.1%),with the least number under 40 years old(11.5%).2.Clinical characteristics of malignant melanoma of the female genital tract in various partsThe incidence rates of vulvar malignant melanoma,vagina malignant melanoma,cervical malignant melanoma,and ovarian malignant melanoma were 42.3%,34.6%,19.2%,and 3.8%,respectively.According to the International Federation of Gynecology and Obstetrics(FIGO)staging standards,there were 11 cases in stage I,8 cases in stage II,6 cases stage III and 1 case in stage IV.Among patients with malignant melanoma of the genital tract,11 patients(42.3%)had clinical manifestations of irregular vaginal bleeding,9 patients(34.6%)had vulvar masses,5 had vaginal wall masses(19.2%),and 1 had vulvar pruritus(3.8%),vaginal contact bleeding in 1 case(3.8%),irregular vaginal discharge in 1 case(3.8%),and pelvic mass in 1 case(3.8%).Patients with vulvar mass as the main complaint accounted for 81.8% of vulvar malignant melanomas,the patients with "irregular vaginal bleeding" as the main complaint accounted for 77.7% of vaginal malignant melanomas,and for80% of cervical-vaginal malignant melanomas.3.The gross pathological characteristics and immunohistochemical expression of malignant melanoma of the female genital tract in various partsIn patients with primary malignant melanoma,17 cases had lesions greater than 2 cm,and 2 cases had lesions less than 2 cm;most of the lesions were nodular and unilateral.There were 18 cases with black lesions,3 cases with purple,and 5 cases with no pigmentation.The average survival time was52.14 months,30.00 months,and 25.75 months,respectively.The survival time of patients with malignant melanoma without pigmentation is shorter than that of patients with higher melanin content.The less pigmentation,the lighter the color,the shorter the survival time.Common tumor markers specific for malignant melanoma are: HMB45,MART-1,S-10,CK,Vimemtin,etc.,which can be expressed as one marker or as multiple tumor markers at the same time.Immunohistochemistry was performed in 23 cases.The expression rate of HMB45 and S-100 was 100%,the expression rate of MART-1 was 91.3%,Vimemtin was 69.5%,and the expression rate of CK was 17.3%.4.Choice of treatment methods and survival conditionsThe 5-year survival rate of vulvar melanoma was 42.3%,of vaginal melanoma was 16.6%,and the follow-up of patients with ovarian malignant is missing.The treatment is mainly surgery,supplemented by immunotherapy,radiotherapy and chemotherapy.On the choice of surgery,the survival time of patients with local surgery was compared with with radical surgery as 54.25 months to 26.25 months.Conclusions:1.The high-risk population of malignant melanoma of female genital tract is postmenopausal elderly women.2.The incidence of malignant melanoma of the vulva is higher than that of vaginal malignant melanoma,cervical malignant melanoma,and ovarian malignant melanoma.3.The main complain of malignant melanoma of the vulva is the mass of the vulva,and main symptom of malignant melanoma of the vagina and cervix is irregular vaginal bleeding.4.According to lesion colour,the cases are divsided into three types:black,purple,and no pigmentation.The survival time of patients with malignant melanoma without pigmentation is shorter than that of patients with higher melanin content,suggesting that the less pigmentation,the shorter the survival time.5.Preoperative diagnosis should be combined with clinical symptoms,pathological biopsy and immunohistochemical staining results.6.Surgery is the main treatment,combined with adjuvant treatment after surgery,which is the most popular clinical approach for malignant melanoma currently. |
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