[Malignant melanoma in gynecology].

The malignant melanoma mostly is situated on the skin, the vulva being more often affected then expected in relation to its share in the total body surface. The peak of incidence lies in the fifth and sixth life decade. Five types of the tumor are known: lentigo maligna melanoma, superficial spreading melanoma, nodular melanoma, acrolentiginous melanoma and non-classifiable melanoma. For estimation of prognosis and choice of adequate mode of therapy histopathological examinations with regard to the level of invasion according to Clark and Chung, histomorphometric evaluation of the depth of invasion suggested by Breslow and the pronostic index of Schmoeckel and Braun-Falco are useful. The operative therapy of choice is the extensive tumor excision. In case of extended local invasion radical vulvectomy is indicated, in certain cases combined with inguinal, sometimes even pelvic lymphonodectomy. In inoperable cases radiotherapy may be tried, but success seems to be poor. Polychemotherapy may induce remissions, but hardly a prolongation of survival. New therapy trials are dealing with immunmodulation, mostly using different substances of biological response modifiers. The prognosis of malignant melanoma of the vulva must be considered to be poorer than that of melanomas in other sites of the body, local recurrence is frequent, the five year survival rate being 30-35%. Whether pregnancy does have an effect on melanoma growth is still unknown. Early stages of melanoma disease may be treated without interrupting pregnancy, whereas advanced stages require termination of pregnancy, followed by specific tumor therapy.