Vaginal mucosal melanoma affects the areas in the vaginal wall, and can also involve the cervix. Mucosal melanoma can also be present solely in the vulvar. These types of melanomas are extremely rare, accounting for only 3% of cancers in this part of the body.
Vaginal mucosal melanoma can be found anywhere in this part of the body, but is usually found in the vaginal wall in the lower third of the vagina. It is sometimes located in the vulva region, and can very rarely involve the cervix.
It starts on the pigment-producing cells (melanocytes) in the lining of the vagina. The melanoma may be darker than the surrounding areas, but in some cases it does not have more pigment or is colourless (amenalotic).
Vulvar mucosal melanoma is more commonly similar to melanoma found in the skin (superficial spreading type of melanoma). Vaginal melanoma is more often a nodular melanoma.
The causes of vaginal and vulvar mucosal melanoma remain largely unknown and may be a combination of age, genetics and environmental factors. Vaginal and vulvar melanoma can be found in women of any age, but it is most common in women over the age of 50.
The most common symptom of vaginal or vulvar melanoma is unexpected bleeding from the area, (bleeding that occurs between periods or after the menopause).
Other possible symptoms include:
It is important to note that 1 in 10 of these types of cancer do not have symptoms, and may be found in a routine cervical screen.
The symptoms are often similar to other symptoms of cancer in the vaginal region. They can also have a non-cancer related cause. It is therefore important to arrange an early appointment with your GP, so they can take the most appropriate action quickly.
If your GP cannot find another cause for these symptoms, you should be referred quickly (normally within about two weeks) to a clinic, in a specialist hospital for tests. This often involves an appointment with a gynaecological cancer consultant. You may also see melanoma specialists and nurse specialists.
It is important to see your GP if you have symptoms or any ongoing unexplained symptoms that are worrying you. If your GP has any concerns or they are not sure what the problem is, they will refer you to a hospital specialist who will examine you and will arrange for you to have a biopsy. This is a small sample of the tissue that will be removed under local anaesthetic to look for cancer cells. It is then analysed by a pathologist (a specialist doctor who diagnoses diseases from tissue and cells in the body) to determine whether it is a melanoma or not. It typically takes a few weeks to receive the results of your biopsy and this can be a very anxious time. You may have other tests to help diagnose vulvo-vaginal melanoma and these tests can also be used to check whether your melanoma has spread to other parts of the body.
After a diagnosis of vulvo-vaginal mucosal melanoma, your medical team will work out the ‘stage’. The stage is a way of describing the key features of your melanoma and is helpful in guiding the best treatment and follow-up for you. Your stage provides an indication of how advanced your melanoma is. Generally, the higher the stage, the more advanced it is.
Staging for vaginal melanoma is different to the standard type for melanoma (American Joint Committee on Cancer – AJCC TNM system). It is more common to use the staging below.
Stage 1= the melanoma is ‘localised’ which means it is in the vaginal area only and has not spread anywhere else
Stage 2= the melanoma has spread to nearby lymph nodes
Stage 3 = the melanoma has spread to another part of your body (metastasised)
Vulvar melanoma is commonly staged like skin melanoma using the TNM system. This is based on how big the tumour is (T), whether it has spread to nearby lymph nodes (N), and if there is spread to other organs (M – metastasis).
> Find more detail about TNM staging for Vulvar mucosal melanoma here
The main treatment for vaginal or vulvar mucosal melanoma is surgery. This is often in a specialised centre, and there should be support from an experienced cancer team.
There are a number of different approaches to surgery for vaginal and vulvar mucosal melanoma, depending on its location and how advanced it is. In planning the operation, the medical team will consider the stage of your vaginal or vulvar mucosal melanoma, your general health and how the surgery may affect your quality of life.
Since this is an intimate part of your body, you may want further support or counselling to help with the emotional aspects and consequences of surgery. Your medical team should be able to provide you with details.
If the vaginal or vulvar mucosal melanoma has spread to other parts of the body, you may be offered other treatments or the option of taking part in a clinical trial. For more information on clinical trials, please visit the Melanoma TrialFinder
If you have any questions about your diagnosis or treatment, our specialised Melanoma Helpline nurses are here to support you on 0808 801 0777
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American cancer society. Staging for Vulvar Mucosal Melanoma https://www.cancer.org/cancer/vulvar-cancer/detection-diagnosis-staging/staging.html
