Vulvo-vaginal melanoma--should radical surgery be abandoned?

A total of 32 patients presenting with melanoma of the vulva and vagina over a 20-year period was reviewed. Primary surgical treatment was by local excision in 14 patients, simple vulvectomy in seven patients and radical resection in 11 patients. Overall 5-year survival was 25% and only one patient was alive at 10 years. Comparison between the groups showed no benefit either in local control, disease-free interval or patient survival according to extent of primary resection. We suggest that, as in anorectal melanoma, radical resection of the primary lesion is unlikely to alter the extremely grave prognosis and its routine use should be abandoned.