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Vulvar melanoma: a multivariable analysis of 644 patients.

Sugiyama VE, Chan JK, Shin JY, Berek JS, Osann K, Kapp DS

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, UCSF Comprehensive Cancer Center, 1600 Divisadero Street, San Francisco, CA, USA.

OBJECTIVES: To determine the prognostic factors associated with the survival of vulvar melanoma patients. METHODS: Data were obtained from the Surveillance Epidemiology and End Results database from 1973 to 2003. Kaplan-Meier survival curves and Cox regression models were used for analysis. RESULTS: Of the 644 vulvar melanoma patients, the median age was 68 years. Of these 572 women were white, 28 were Hispanic, 18 were African-American, and 14 were Asian. A total of 302 had localized disease, 168 had regional disease, and 28 had distant disease. Of the participants who underwent surgical resection, 171 (26.6%) had conservative surgery, 164 (25.5%) had radical excision, and 241 (37.5%) had unspecified surgical resections. One hundred seventy-nine (27.8%) had lymph node resections, and 33 patients had concurrent radiation therapy. Nodal metastases were identified in 58 (9%) of the participants. The 5-year disease-specific survival rates for those with localized, regional, and distant disease were 75.5%, 38.7%, and 22.1%, respectively (P<.001). Women aged 68 years or younger had a better survival rate than older patients (72.0% compared with 47.7%; P<.001). Those with 0, 1, and 2 or more positive lymph nodes had survival rates of 68.3%, 29%, and 19.5%, respectively (P<.001). In a multivariable analysis, younger age, localized disease, and negative lymph nodes were independent prognostic factors for improved survival. CONCLUSION: Age, stage, and lymph node involvement were significant factors for survival in vulvar melanoma. LEVEL OF EVIDENCE: III.

Published 1 August 2007 in Obstet Gynecol, 110(2): 296-301.
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