Title: Recurrent Vulvar Melanoma: Diagnostic and Therapeutic Challenges - A Case Report
Authors: S.BOUMAAZA , Fz FDILI ALAOUI , Z. TAZI , Y.BELHAJ , S.JAYI , H. CHAARA and MyAbdeillah MELHOUF
Volume: 10
Issue: 5
Pages: 7-13
Publication Date: 2026/05/28
Abstract:
: Malignant melanoma is an aggressive and potentially life-threatening tumor that can arise from both cutaneous and mucosal sites. Among these, vulvar melanoma (VM) represents a rare gynecological entity, accounting for approximately 5% of vulvar malignancies and 1% of all melanomas in women. It predominantly affects elderly, mostly Caucasian women. Its association with ultraviolet exposure remains controversial due to the mucosal nature of this location. Recurrence of vulvar melanoma, although the primary disease itself is rare, represents an even more exceptional and challenging clinical situation, owing to the intrinsic aggressiveness of the tumor and the lack of well-established, standardized management guidelines. The diagnosis is primarily based on histopathological examination following biopsy, supported by clinical, dermoscopic, and microscopic features. At the molecular level, vulvar melanoma differs from cutaneous melanoma by a higher frequency of KIT gene mutations, which can be detected through conventional sequencing, next-generation sequencing, or immunohistochemistry. Mutations in BRAF and NRAS genes may also be observed, although less consistently. These molecular alterations represent potential therapeutic targets, paving the way for targeted therapies in selected cases. To date, the management of primary vulvar melanoma relies mainly on surgery, consisting of wide local excision with or without lymph node assessment. However, the role of neoadjuvant and adjuvant therapies remains limited and insufficiently documented due to the lack of randomized controlled trials. The management of recurrent disease, which is relatively frequent in this location, remains controversial, particularly regarding the role of re-excision, radiotherapy, and systemic treatments such as immunotherapy and targeted therapy. We report the case of a 60-year-old woman with a history of left vulvar melanoma staged as pT4bN1a, initially treated with hemivulvectomy and bilateral inguinal lymph node dissection, followed by a single course of adjuvant chemotherapy. The patient was referred to our department for the appearance of a right vulvar mass, revealing an unusual pattern of recurrence and highlighting the rarity of this presentation.