What to know about vulvar melanoma

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Vulvar melanoma is a rare type of melanoma — accounting for about 5% of all vulvar cancers — that affects the mucous surfaces of the structures that make up the vulva.

Vulva is a general term that refers to the external structures of female genitalia that include parts, such as the clitoris, vaginal opening, and labia, among others.

Melanoma is an aggressive type of cancer that typically appears on the skin. About 1% of all females with melanomas have vulvar melanoma.

The outlook for vulvar melanoma is lower compared to other melanomas. The overall 5-year survival rate for vulvar melanoma is 47%. On the other hand, the 5-year survival rate for cutaneous melanoma — melanoma of the skin — is 92%.

Survival rates represent the percentage of people still living 5 years after their initial diagnosis. It cannot predict another person’s outcome. Several factors, including age, overall health, and the cancer’s stage, can all influence a person’s chances of survival. A person should speak with a healthcare professional about their specific outlook.

Vulvar melanoma typically appears on the labia majora, labia minora, and clitoral hood.

Early stages may not present with any symptoms. For some, vulvar melanoma may remain asymptomatic.

Some potential signs or symptoms can include:

• abnormal vaginal discharge
• bleeding
• itching
• an abnormal bump

The presence of these symptoms does not indicate vulvar melanoma, though. Several benign conditions can cause similar symptoms.

In later stages, a person may notice lymphadenopathy — swelling of local lymph nodes. Some people may notice urinary blockage.

A person who experiences any unusual symptoms or a lump in their vulva should consider seeing a healthcare professional for an assessment.

Vulvar melanoma develops due to changes in a person’s cells that cause them to grow out of control. Though the exact underlying cause remains unknown, experts suspect a combination of environmental and genetic exposures may cause a mutation in the vulvar cells.

Researchers have looked into several molecular profiles associated with vulvar melanoma. Though consensus on the particular changes present remains under investigation, future researchers hope to use the information to guide diagnosis and treatment.

Unlike melanomas that affect the skin, there are no known risk factors for vulvar melanoma. Neither artificial light nor sunlight exposure are risk factors.

Reports of the average age of development of vulvar melanoma vary due to its rarity. The average age generally ranges between 54–68 years. However, people can develop it at any age.

The diagnostic process may begin at a gynecology appointment, where a doctor might identify a growth or unusual symptoms.

If a healthcare professional suspects possible cancer, they will likely order imaging tests, such as MRI or CT scans. These can help identify tumors and determine if the cancer has spread to local or distant structures.

The average size of a tumor at diagnosis is about 3 centimeters (cm).

During the diagnostic process, healthcare professionals will need to rule out benign growths that can occur on the vulva. A biopsy can help provide information on the nature of a tumor and help aid diagnosis.

Following diagnosis, healthcare professionals will stage the cancer. Experts suggest doctors use the staging system from the American Joint Committee on Cancer (AJCC) over the staging system from the International Federation of Gynecology and Obstetrics – most commonly referred to as FIGO, an acronym of its French name. The AJCC staging system provides a better overall prognosis than the FIGO system.

Experts suspect diagnosis often gets delayed due to the asymptomatic nature of the cancer. Finding vulvar melanoma in earlier stages may help improve a person’s outlook.

The primary treatment for vulvar melanoma involves surgical removal of the tumor and lymph nodes. A 2020 study notes that surgery helps improve the overall survival of people with vulvar melanoma, supporting the findings of previous studies.

However, there is still no consensus on exactly how large the surgical margins should be. Surgical margins refer to the amount of healthy tissue removed along with the tumor. Some experts suggest following the guidelines used for removing cutaneous melanomas.

Chemotherapy does not provide effective treatment for the majority of people living with vulvar melanomas. Surgeons may recommend radiation if they do not believe they can achieve negative margins — remove all of the tumor — but this treatment’s effectiveness is largely unproven.

The use of immunotherapy has increased in recent years, but it still does not show statistically significant improvement in overall survival.

Future studies will look into the molecular profile of vulvar melanoma to help find new, effective treatment options.

The following sections provide answers to frequently asked questions about vulvar melanoma.

What can be mistaken for vulvar melanoma?

Vulvar melanoma is one of several different growths that can occur on the vulva. Growths that look similar, which healthcare professionals need to rule out include:

• post-inflammatory hyperpigmentation
• differentiated vulvar intraepithelial neoplasia
• genital nevi
• pigmented seborrheic keratosis
• low and high grade squamous intraepithelial lesions
• vulvar melanosis

Distinguishing between the different types of growths can be challenging. A doctor will likely order a biopsy to help identify cancer cells.

Is vulvar melanoma serious?

Vulvar melanoma is a rare, potentially fatal form of melanoma that grows on the vulva. Diagnosis often gets delayed due to a lack of symptoms and limited self-inspection.

The overall 5-year survival rate for vulvar melanoma is 47%. This means about 47% of people diagnosed with vulvar melanoma are still alive 5 years following the initial diagnosis.

What are the early signs of vulvar melanoma?

Vulvar melanoma often does not show signs in the early stages of the disease. When and if symptoms do occur, they can include:

• the presence of a discolored lump or bump
• itchiness
• abnormal vaginal discharge
• bleeding

Vulvar melanoma is a rare form of melanoma that appears on the structures of the vulva.

It may not cause signs or symptoms. When it does, they are nonspecific and can include itchiness, bleeding, and a discolored lump or bump.

Doctors need to rule out other types of tumors, including benign ones for a diagnosis. Once diagnosed, treatment often involves surgical removal of the tumor. Doctors may recommend additional treatments, but they are often not effective.

Future studies will continue to look for effective treatment options for people with vulvar melanoma.