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Review
. 2021 Oct 21;28(6):4264-4272.
doi: 10.3390/curroncol28060362.

Management of Clitoral Melanoma Presenting as an Exophytic Clitoral Mass: A Case Report and Review of the Literature

Alec Szlachta-McGinn  1 , Bartosz Chmielowski  2 , Yuna Kang  3 , Steven Raman  4 , Sanaz Memarzadeh  1   5   6   7   8
Affiliations
Review

Management of Clitoral Melanoma Presenting as an Exophytic Clitoral Mass: A Case Report and Review of the Literature

Alec Szlachta-McGinn et al. Curr Oncol. .

Abstract

Primary mucosal melanomas of the female genital tract account for one percent or less of all cases of melanoma with even fewer originating in the clitoris. Given the rarity of diagnosis of clitoral melanoma, there is a paucity of data guiding management. There is no supporting evidence that radical vulvectomy (with or without inguinal lymphadenopathy) is associated with improved disease-free or overall survival compared to partial vulvectomy or wide local excision. Additionally, there is no data to evaluate the role of sentinel lymph node biopsy or extensive lymphadenectomy in clitoral melanoma, however previous evidence demonstrates the utility of regional lymph node sampling in predicting survival in women with female genital tract mucosal melanoma. Adjuvant therapy considerations are often extrapolated from their use in treating cutaneous melanomas, including immune checkpoint inhibitors and other immunotherapy agents. Adjuvant radiation therapy has limited utility except in cases of bulky, unresectable disease, or when inguinal lymph nodes are positive for metastasis. The 52 year-old patient presented in this review was diagnosed with locally invasive advanced stage clitoral melanoma presenting as an exophytic clitoral mass. She underwent diagnostic primary tumor resection, which demonstrated ulcerative melanoma with spindle cell features extending to a Breslow depth of at least 28 mm. She subsequently underwent secondary wide local excision with groin sentinel lymph node biopsy, and adjuvant treatment with pembrolizumab. This article also emphasizes the importance of a multidisciplinary team involving gynecologic oncology, medical oncology, radiology, and pathology for management of this rare type of primary mucosal melanoma of the female genital tract.

Keywords: clitoral melanoma; female genital tract melanoma; mucosal melanoma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Clitoral mass on preoperative physical exam.
Figure 2
Figure 2
Imaging findings from MRI of pelvis. (A) Axial T2 image of the pelvis shows a heterogenous, well circumscribed T2 hyperintense clitoral mass with T2 hypointense margin with internal low signal (yellow arrows). (B) On axial T1, the lesion is hypointense, typical of most malignancies (yellow arrows). (C) On axial diffusion weighted imaging (DWI) with B = 800, the clitoral mass is bright (restricting) suggesting high cellularity (yellow arrows). (D) On axial dynamic T1 post contrast, the clitoral mass progressively enhances.
Figure 3
Figure 3
Representative pathology slides from the primary excision of the exophytic clitoral mass demonstrating melanoma. (A) Hematoxylin and eosin (H&E) stain (low power, 0.4×), clitoral tumor. (B) H&E (10×), invasive melanoma with spindled cell morphology with overlying in-situ component. (C) SOX10 immunohistochemical stain (10×), positive SOX10 expression in the in-situ and invasive components of the melanoma.
Figure 4
Figure 4
Imaging findings from whole body PET CT. On fused FDG PET CT, after resection, there is no evidence of inguinal lymphadenopathy (yellow arrows).
Figure 5
Figure 5
H&E (10×), melanoma in-situ identified in the re-excision specimen.
See this image and copyright information in PMC

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