Vulvar melanoma: a report of 20 cases and review of the literature.

BACKGROUND: Vulvar melanoma is the second most common vulvar malignancy and represents a significant women's health issue. OBJECTIVE: To report experience with 21 cases of vulvar melanoma in 20 patients and to review the literature about the condition. METHODS: Parameters retrospectively reviewed included age at diagnosis, family history of melanoma, location on the vulva, atypical nevi, Breslow depth, ulceration status, histologic pattern, presenting signs and symptoms, and the results of sentinel lymph node biopsy. Molecular characterization of the melanocortin type 1 receptor was performed in 1 patient. RESULTS: A family history of cutaneous melanoma was present in 15% of cases. The mean Breslow depth was 2.8 mm (range, 0.0-11.0 mm). Ten patients successfully underwent sentinel lymph node biopsy, results of which were positive in 2 (20%). Reported for the first time is that one patient had a germline mutation in the melanocortin type 1 receptor. CONCLUSION: Vulvar and cutaneous melanoma behave similarly despite their unique pathogeneses. Sentinel lymph node biopsy can be performed successfully for vulvar melanoma.

Prognostic value of positron emission tomography using F-18-fluorodeoxyglucose in patients with cervical cancer undergoing radiotherapy.

OBJECTIVE: The purpose of this study was to determine whether positron emission tomography (PET) using F-18-fluorodeoxyglucose (FDG) before and after radiotherapy would predict whether local control of cervical cancer had been achieved. METHODS: FDG-PET scans were performed prior to therapy and at a mean of 4.6 months after radiation in 20 patients (pts) with histologically proven uterine cervical cancer who were undergoing a "curative" course of radiation therapy. FDG uptake was interpreted visually by two readers using a 5-point grading system (0 = normal, 1 = probably normal, 2 = equivocal, 3 = probably abnormal, and 4 = definitely abnormal). The standardized uptake values corrected by lean body mass (SUL) were calculated for suspicious areas. The percentage of residual activity (%RA) for the posttherapy SUL was also evaluated as a percentage of the pretherapy SUL. RESULTS: At baseline before irradiation, 17 of 20 (85.0%) primary tumors were detected. Following irradiation, no or low (grade 0-2) uptake was observed in 9 pts, and none of these had local recurrence. Among the remaining 11 pts with grade 3 or 4 uptake, the correct diagnosis was made for 5 pts with active tumor; SULs (mean +/- SD = 4.17 +/- 2.52) and %RAs (57.9 +/- 16.8). Six patients without active tumor showed relatively low SULs (2.67 +/- 0.69) and %RAs (43.0 +/- 18.3). No significant differences were observed between the recurrent and nonrecurrent groups for these parameters. Overall, sensitivity, specificity, and accuracy were 100, 60, and 70%, respectively. CONCLUSION: These preliminary data indicate that FDG-PET is a sensitive tool for detecting active cervical cancer after radiation, however, the method, without anatomic correlation had suboptimal specificity.