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Abstract: A 68-year-old woman had a vulvar melanoma for 15 years and had local itching for six months. She did not care about it at first and did not relieve it after self-medication, so she came to the hospital. The patient was recommended to be hospitalized, and the lesion was surgically removed with follow-up chemotherapy. The patient’s condition is stable and has not recurred since the follow-up.
Basic information】Female, 68 years old
Disease Type】Melanoma of vulva
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】July 4, 2018
Treatment plan】Surgery (extensive vulvectomy + total hysterectomy) + rehydration therapy (5% glucose injection + compound sodium chloride injection) + anti-infection therapy (cefuroxime sodium for injection) + chemotherapy (vincristine sulfate for injection) + symptomatic therapy (vitamin B6 injection)
[Treatment period] 14 months after surgery plus chemotherapy, followed up to date
Treatment effect] The lesion was removed, and the disease is stable, no recurrence since the follow-up.
I. Initial consultation
The patient came to the outpatient clinic on July 4, 2018, and reported having a vulvar nevus with black pigmentation for 15 years and itching for six months. She thought it was caused by friction of her underwear, so she applied erythromycin ointment, mupirocin ointment and other medications on her own, but her clinical symptoms were not relieved, so she came to the hospital for consultation. On examination, the patient’s appearance was normal, premature beats could be heard occasionally on heart auscultation, respiratory sounds in both lungs were clear, no abnormalities were seen in the abdomen, vulva development was normal, scattered black tumors of 3×3×2cm in size were seen in the left vulva near the groin, with a little exudation on the surface, the border was still clear, the base below the black elevation was hard and inactive when touched by hand, vaginal discharge was not much, vaginal folds disappeared, cervix was smooth, uterus was atrophied, bilateral There was no abnormality in the annexe area, normal leucorrhoea, normal blood count, normal coagulation time, and occasional premature beats in the electrocardiogram. Color ultrasonography: a black mass of 3×3×2 cm in size was seen in the left vulva near the groin, with rich blood flow signal below and unclear boundary.
II. Treatment history
After detailed communication with the patient and her family about her condition, she decided to receive surgical treatment. After completing all preoperative examinations and preparations, the patient underwent extensive vulvectomy + total hysterectomy under general anesthesia. The excised vulvar tissue and uterus were sent for pathological examination, and the results were the same as the first pathological examination, but there were metastases in the lymph nodes and no abnormal pathology in the uterus. Postoperatively, 5% glucose injection plus compound sodium chloride injection was applied for rehydration, and cefuroxime sodium for injection was applied for anti-infection treatment. After the patient’s condition improved, he was discharged on August 2, 2018, and the patient was instructed for the next admission before discharge, and on September 5, 2018, the patient was readmitted for the first time to chemotherapy with injectable vincristine sulfate for a total of five times. Due to the patient’s poor tolerance of chemotherapy, severe vomiting and wasting body unable to eat, vitamin B6 injection was given, and the patient was operated plus chemotherapy for a total of 14 months before and after, and the disease has not recurred since the follow-up.
III. Treatment effect
After surgery and drug treatment, the patient’s local lesion and vulva were all excised, the wound healed well, there was no local redness and swelling, no abnormal exudation, stable vital signs, no fever, and no abnormal heart and lung auscultation. The gynecological examination showed no abnormal redness or swelling in the vulva and no enlargement of inguinal lymph nodes. After follow-up, no recurrence or metastasis of the lesion was found. A pelvic CT scan was performed in the third year after surgery, and no abnormality was found.
IV. Precautions
We are glad that the patient has recovered after the surgical treatment and chemotherapy. She was advised to continue resting after discharge, avoid long-term squatting or sitting, keep her bowels unobstructed, eat more food rich in dietary fiber, consult a doctor promptly in case of constipation, use medication under the doctor’s guidance, and avoid straining the bowels, which leads to local congestion and edema of the vulva. Sexual intercourse is prohibited for 3 months after surgery.
V. Personal insight
Dark pigmented nevus is one of the common skin diseases. If it is located locally in vulva, factors such as friction of underwear, friction of sexual life and friction of sanitary napkin during menstruation will stimulate it and increase its chance of malignant transformation, thus melanoma will occur. Therefore, for localized melanoma of vulva, surgical excision treatment should be considered as soon as possible, and the excised tissues should be sent for pathological examination, and once it is found to have malignant transformation into vulvar melanoma, it should be treated as soon as possible. In this case, the patient had a better prognosis because no uterine metastasis occurred and she was actively treated.