Exam Question of the Day - February 4, 2014

By drwall
February 4, 2014

An excision is performed on the vulva and is diagnosed as vulvar melanoma. Depth of invasion is noted 1.5 mm depth on invasion. The next step is to:

A.Observation
B. Local excision with 2-3 cm margin
C.To treat by radical vulvectomy with nodal dissection
D.Radiation therapy
E.Chemotherapy
Answer: B
Comprehensive Gynecology 6th Ed.  pgs. 699-701

Melanoma is the most frequent non-squamous cell malignancy of vulva. It comprises approximately 5% of primary cancers of this area.  As is true elsewhere in the body melanomas arise from junctional or compound nevi. Pigmented lesions of the vulva are usually junctional nevi and all such lesions should be removed by excision.

Excision margins have been extensively studied for cutaneous melanomas. Veronesi and colleagues have found that cutaneous melanomas smaller tan 2mm thick could be adequately treated with a 1 cm margin which was as effective as a 3cm margin for thin lesions. Although comparable date do not exist for vulvar melanomas evidence from studies of cutaneous melanomas, evidence from studies of cutaneous melanomas has suggested that 1 cm margin may be used for very thin vulvar melanomas. In a report of 36 melanomas cases rose and associates noted that wide excision was effective as radical vulvectomy

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