Multifocal Malignant Melanoma of Female Genital Tract

A 75-year-old patient was referred with vaginal bleeding. Her physical exam showed two flat dark plaques on the posterior fourchette, mostly on left lateral side of the vulva, A black soft mucosal nodule was present on the left lateral side of upper vagina, and a polypoid ulcerative cervical lesion extended into the right parametrium. Cervical and vaginal biopsies were in favor of malignant melanoma, while vulvar biopsy was in favor of lentigo maligna melanoma. The diagnosis was confirmed using immunohistochemical studies with SI 00 and HMB 45. The patient was treated by wide local excision of the vulvar lesion followed by high-doses of fractionation radiotherapy of the cervix and upper vagina. Due to advanced and aggressive melanoma of the cervix, in comparison to the lentigo maligna of the vulva, and the presence of vaginal melanomas on the opposite site of the cervical lesion, it is suggested that the origin of these two lesions are multi focal rather than the direct extension.