Primary melanoma of the uterine cervix after supracervical hysterectomy. A case report.

BACKGROUND: Primary malignant melanomas of the uterine cervix are uncommon. We describe an unusual case occurring in a woman with a previous supracervical hysterectomy. CASE: A 63-year-old woman with a history ofsupracervical hysterectomy forfibroids was found to have a high grade squamous intraepithelial lesion on routine Papanicolaou smear and underwent cervical cone excision. Microscopic examination of the cervical cone biopsy showed highly dysplastic cells within the ectocervical mucosa as well as in the underlying stroma. The dysplastic cells were amelanotic and demonstrated immunoreactivity to S-100 protein and HMB-45. There was no evidence of immunoreactivity to leukocyte common antigen or AE1/AE3. Diagnosis of malignant melanoma was made. Subsequently the patient underwent trachelectomy and pelvic lymphadenectomy. Residual malignant melanoma involving the ectocervical squamous mucosa was noted, but bilateral pelvic lymph nodes were negative for metastatic melanoma. The patient had no prior history of cutaneous melanoma or other malignancies. She experienced a local recurrence 1 year after surgery.
CONCLUSION: To our knowledge, this is the first published case report of primary melanoma of the cervix occurring after supracervical hysterectomy. Although uncommon, melanoma should be considered in the differential diagnosis of high grade dysplasia. This case also demonstrates the importance of the routine annual Papanicolaou smear, not just for high-risk women and cervical cancer but also for older women and those with supracervical hysterectomy.