Melanomas of the uterine cervix and vagina

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Gynaecological melanomas are rare neoplasms that affect the vulva in 4% of cases, the vagina in 2% and the uterine cervix in less than 1% of cases.
Usually melanomas are tumours that originate from melanocytes, pigment-producing cells that give skin its colour. But in some cases these tumours may also develop in the mucous surfaces, such as for example the vagina, the cervix, uterus, ovaries, oral mucous membranes and male genital organs.

In addition to being particularly rare, melanomas of the uterine cervix and vagina are extremely aggressive pathologies, with a usually unfavourable prognosis, and mortality rates of 20-50% 5 years after the tumour is treated. 

In addition, these cancers of the uterine cervix and vagina are often detected late due to different factors. First of all, this type of melanoma is usually asymptomatic up to very advanced stages of the disease. In addition, during a gynaecological exam, the speculum may also cover more than 50% of the vaginal walls, and this may conceal those areas that more pigmented. Finally, it must be taken into account that the vagina is still one of the least studied organs in medicine.

Causes of melanomas of the uterine cervix and vagina

The causes of melanomas of the uterine cervix and vagina are still not known but cannot be connected to those causing skin melanomas. In fact, the determining factor for the latter is ultraviolet rays due to sun exposure, but it is clear that for the vagina and uterine cervix, damage caused by direct exposure to sun cannot be a factor for these two parts of the body. 
There are some risk factors that can contribute to develop melanomas of the uterine cervix and vagina, such as:

• Age > 50
• Smoking habit
• Unhealthy lifestyle
• Human papillomavirus (HPV) infection
• HIV positive
• Immunodeficiency disorders
• Other tumours of the genital area

These risk factors are common to all forms of tumours of the vagina and surrounding areas.

Symptoms of melanomas of the uterine cervix and vagina

As we have previously analysed, these types of tumours of the uterine cervix and vagina are often asymptomatic.
In some cases, usually when the melanoma is at an advanced stage, it shows some symptoms such as:

• Abnormal vaginal discharges
• Vaginal bleeding between periods
• Vaginal bleeding after intercourse
• Pelvic or vaginal pain
• Painful urination
• Pain during sexual intercourses
• Constipation
• Burning sensation

Diagnosis of melanomas of the uterine cervix and vagina

The best weapon against tumours of the vagina, vulva and uterine cervix is early diagnosis, which can be achieved only by regular visits to the gynaecologist and screenings- Pap or HPV tests.

In fact, prognosis varies according to the location of the mass, depth of invasion, mitotic index and the presence of aneuploidy and ulceration. Prognosis worsens as the tumour metastasizes from the vagina to one or more inguinal lymphatic ganglia: a melanoma can in fact reach other parts of the body, both lymphatically and through the blood.

In case of suspected melanoma of the uterine cervix and vagina, a complete picture of the lesion should be evaluated by means of:

• Gynaecological exam
• Medical history of the patient
• Colposcopy

After these tests and once the critical areas have been identified, the suspicious tissue must be analysed. In fact, biopsy is still one of the most important diagnostic methods in the field of tumours.

Once the melanoma is identified, diagnostic imaging tests (such as CT scans, MRI and X-rays) are required in order to understand the extent of spread of the disease in the other organs of the body.

Treatment of melanomas of the uterine cervix and vagina

The treatment of gynaecological melanomas depends on a series of factors, such as the size and location of the tumour, the patient's age and physical condition. In addition, due to the rarity of these tumours it is difficult to identify an effective therapeutic strategy.

Usually, treating these melanomas involves surgical resection, while if tumours are in an advanced stage, chemotherapy can be used. For cases of particularly hard-to-treat tumours, radiation therapy with carbon ions is considered a potentially effective non-invasive treatment.