Multidisciplinary Approach in the Management of Primary Malignant Melanoma of the Uterine Cervix: Diagnostic and Management Challenges

Abstract

Abstract

Background:

Primary cervical malignant melanoma (MM), a very rare disease of the lower genital tract, has a poor prognosis. The diagnosis remains a challenge and the management is not standardized.

Case:

A primary cervical MM developed in a woman, age 44, who presented with menorrhagia and intermenstrual bleeding. A biopsy of a 5-cm, pigmented, exophytic cervical mass was reported locally as an undifferentiated cervical stromal sarcoma. The case was reviewed by a central gynecologic oncology multidisciplinary team (MDT). Additional immunohistochemistry testing revealed a primary cervical MM, which was staged as International Federation of Gynecology and Obstetrics (FIGO) 1B₂. The patient underwent open radical hysterectomy, bilateral salpingo-oophorectomy and bilateral, pelvic lymph node dissection, with no adjuvant treatment.

Results:

She remained well at a follow-up in the last 20 months, with no evidence of recurrence.

Conclusions:

Primary cervical MM may be included in the differential diagnosis of premenopausal women diagnosed with cervical cancer. Central MDT review is key for making an accurate diagnosis of such a rare entity. Surgical intervention without any adjuvant treatment may be applied in FIGO stage 1 cases if satisfactory clear margins can be achieved and if there is no nodal involvement. Only in cases of BRAF or KIT mutations would adjuvant immunotherapy be considered. (J GYNECOL SURG 34:209)