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Abstract: In this article, a small black mole on the vulva appeared to be enlarged, itchy and painful, with surface ulceration and bleeding within a short period of time. The patient treated herself as a common disease and delayed treatment, and finally went to the hospital outpatient clinic for tissue biopsy pathological examination before the diagnosis was confirmed.
Basic information】Female, 66 years old
Disease Type】Vulvar malignant melanoma
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】May 2022
Treatment plan】Surgical treatment (local excision of the lesion) + intravenous injection (Ceftriaxone sodium for injection + metronidazole injection) + vulvar disinfection and cleaning + perineal wound illumination
Treatment Period】7 days of hospitalization
Treatment effect】Surgical excision of the lesion, the disease was controlled, and radiotherapy was continued.
I. Initial consultation
The patient, a 66-year-old female, reported that she had occasional vulvar itching in the past, which could be relieved by herself, but in the past month, she had obvious itching symptoms on the left side of her vulva near the vaginal opening, and thought it was vulvovaginitis. After scratching, the patient had a little bleeding, and her daughter saw a small nevus at the left labia minora, and gave her Yunnan Baiyao powder to stop the bleeding. Five days later, the biopsy result was reported as malignant melanoma with Clark grade IV, and she was admitted to hospital.
II. Treatment history
The patient and family members were informed that malignant melanoma of vulva is rare in clinical practice, with a high degree of malignancy and a poor prognosis. The patient and his family agreed to operate as soon as possible after understanding his condition. After perfecting relevant preoperative examination and preoperative preparation, the patient was sent to the operating room on the third day of hospitalization for local excision of the lesion, and the surgical margin was about 1.5 cm from the edge of the lesion.
The patient was given anti-inflammatory treatment with injectable ceftriaxone sodium and metronidazole injection after surgery, and was given daily vulvar disinfection and washing. The pathological results on the 5th postoperative day reported malignant melanoma with Clark grade IV, tumor thickness of 1 mm, nuclear division count of 2 cells/mm2, ulcer formation, and a few lymphocytes in the tumor, which was consistent with the clinical presentation.
III. Treatment effect
The patient’s condition was basically recovered after 7 days postoperative checkup, and no abnormal vital signs such as respiration, heart rate and blood pressure, no fever, good perineal wound healing, no pruritus, no abscess, no redness, no bleeding, and the vulvar epidermal ulcerated surface had been initially healed after treatment, while no other complications occurred, and the patient was discharged.
IV. Notes
The patient’s condition was basically controlled, and we were sincerely happy for the patient. We advised the patient to pay attention to personal hygiene, prevent wound infection, wear loose and breathable pants as much as possible, walk less before the wound is completely healed, avoid rubbing the wound; pay attention to the regularity of work and rest, keep sufficient sleep, and eat a light diet.
V. Personal insight
Malignant melanoma of vulva is mostly seen in elderly women, with high malignancy and generally bad prognosis. In addition, some patients with the disease are already older and have difficulty in tolerating larger surgery and long postoperative radiotherapy, so it will affect the effect of treatment. Melanoma often occurs around the labia minora and clitoris, with symptoms of itching, pain and bleeding, and tends to increase rapidly in a short period of time. When symptoms appear, you should seek medical attention as early as possible, as with this patient, and early diagnosis and treatment will usually result in a relatively better prognosis.