Sarah E Sinasac1, Teresa M Petrella2, Marjan Rouzbahman3, Shachar Sade4, Danny Ghazarian3, Danielle Vicus5. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON. Electronic address: sarah.sinasac@thp.ca. 2. Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON. 3. Department of Anatomical Pathology, University Health Network, Toronto, ON. 4. Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
Abstract
OBJECTIVE: This study sought to evaluate the clinicopathologic features, surgical management, and survival of patients over 12 years at two academic centres. METHODS: Patients diagnosed with vulvar or vaginal melanoma between 2002 and 2014 were identified through pathology databases. Clinical and pathologic data were extracted from the medical records. The Kaplan-Meier method was used to calculate recurrence-free survival and overall survival (OS), and univariate analyses using a Cox proportional hazard model were used to detect covariates related to survival. RESULTS: Patients with vulvar melanoma were more likely to undergo surgical excision (84.0% vs. 55.6%, P = 0.0243) and were more likely to achieve negative margins (70.0% vs. 16.7%, P < 0.0001). Forty-eight percent of patients with vulvar melanoma had a lymph node evaluation; sentinel node biopsies were performed in 32%. Actuarial median OS for vulvar melanoma was 45 months compared with 10.48 months for vaginal melanoma. A subset of 10 patients with vulvar melanoma who survived longer than 60 months was identified. Eight significant predictors of OS were demonstrated for vulvar melanomas: clinical stage, maximum tumour size, tumour thickness, lymphovascular space invasion status, clinically enlarged lymph nodes, sentinel lymph nodes, lymph node status, and radiation treatment. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins (hazard ratio 2.60; 95% CI 1.14-5.90). CONCLUSION: Surgical excision with adequate margins is the mainstay of primary management when feasible. Lymph node evaluation, including sentinel nodes, may be considered in selected patients. Vulvar and vaginal sites differ markedly with respect to pathology, initial management, and survival, and they should be evaluated separately.
OBJECTIVE: This study sought to evaluate the clinicopathologic features, surgical management, and survival of patients over 12 years at two academic centres. METHODS:Patients diagnosed with vulvar or vaginal melanoma between 2002 and 2014 were identified through pathology databases. Clinical and pathologic data were extracted from the medical records. The Kaplan-Meier method was used to calculate recurrence-free survival and overall survival (OS), and univariate analyses using a Cox proportional hazard model were used to detect covariates related to survival. RESULTS:Patients with vulvar melanoma were more likely to undergo surgical excision (84.0% vs. 55.6%, P = 0.0243) and were more likely to achieve negative margins (70.0% vs. 16.7%, P < 0.0001). Forty-eight percent of patients with vulvar melanoma had a lymph node evaluation; sentinel node biopsies were performed in 32%. Actuarial median OS for vulvar melanoma was 45 months compared with 10.48 months for vaginal melanoma. A subset of 10 patients with vulvar melanoma who survived longer than 60 months was identified. Eight significant predictors of OS were demonstrated for vulvar melanomas: clinical stage, maximum tumour size, tumour thickness, lymphovascular space invasion status, clinically enlarged lymph nodes, sentinel lymph nodes, lymph node status, and radiation treatment. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins (hazard ratio 2.60; 95% CI 1.14-5.90). CONCLUSION: Surgical excision with adequate margins is the mainstay of primary management when feasible. Lymph node evaluation, including sentinel nodes, may be considered in selected patients. Vulvar and vaginal sites differ markedly with respect to pathology, initial management, and survival, and they should be evaluated separately.
Authors: Mitul B Modi; Phyllis A Gimotty; Michael E Ming; Neha Jariwala; Rosalie Elenitsas; Chris Miller; Emily Y Chu; Hanna Lindner; Ata S Moshiri; Lauren E Schwartz; Priti Lal; Maria C Reyes; David E Elder; Xiaowei Xu Journal: Hum Pathol Date: 2020-07-20 Impact factor: 3.466
Authors: Elena-Codruța Dobrică; Cristina Vâjâitu; Carmen Elena Condrat; Dragoș Crețoiu; Ileana Popa; Bogdan Severus Gaspar; Nicolae Suciu; Sanda Maria Crețoiu; Valentin Nicolae Varlas Journal: Biomedicines Date: 2021-06-30