Melanoma

Although not commonly encountered in routine practice, melanoma is the second most common vulvar invasive malignancy after squamous cell carcinoma (Fig. 34A and B) (See chapter on pigmented lesions of the vulva) (59). Pigmented lesions of the vulva must be viewed with this in mind, as prognosis for melanoma relates to depth of invasion (thickness), and hence early diagnosis is critical. The cells of melanoma may percolate up through the epithelium in a manner similar to Paget's cells, but can be distinguished by their staining for HMB-45, S100, or Melan-A. Therapy is surgical. Depth of invasion is measured differently than in squamous cell carcinoma (where it is measured from the most adjacent dermal papilla), utilizing a Breslow thickness, which is the entire thickness of the lesion from the top of the granular layer, excluding the acellular keratin to the deepest area of invasion. Chung's levels, a variant on the Clark's levels used for cutaneous melanoma, have also been applied, recognizing the difference in vulvar skin (lack of a distinct papillary and reticular dermis) (Table 34).

Growth Labia Minora

Figure 34 Melanoma. (A) Darkly pigmented lesion. (B) (See color insert) The lesion is often composed of epithelioid cells with prominent nucleoli. Melanin pigment may be present or not. Melanomas may mimic a variety of neoplasms, and a variety of stains are available to confirm the nature of the lesion.

Figure 34 Melanoma. (A) Darkly pigmented lesion. (B) (See color insert) The lesion is often composed of epithelioid cells with prominent nucleoli. Melanin pigment may be present or not. Melanomas may mimic a variety of neoplasms, and a variety of stains are available to confirm the nature of the lesion.

Diagnosis

Symptoms

Appearance

Differential diagnosis

Therapy

Melanoma

None, mass,

Usually raised, pigmented,

Other pig-

Surgical

itch

often on labia minora or

mented

clitoris (59)

lesions

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