Letters to the editor
metastases in the lungs, subcutaneous tissue, stomach and right femur. Given the poor prognosis of metastatic penile melanoma, the patient enrolled in hospice care and is currently alive. Primary vaginal melanoma most commonly afflicts elderly, Caucasian and post-menopausal women while penile melanoma affects men in their fifties and sixties.1,2 Although a higher proportion of melanomas are mucosal in Hispanics, Asians and African Americans (due to the lower incidence of cutaneous melanomas in these populations), the absolute incidence of mucosal melanomas is higher in Caucasians for an unknown reason.5 Ultraviolet light, a risk factor for cutaneous melanoma, is not a risk factor for genital melanoma as the incidence of mucosal melanomas is not increased in southern geographic regions. Human papillomavirus and human herpes virus do not appear to play a role either.6 Of note, recent studies indicate that while cutaneous melanomas frequently carry BRAF (serine/threonine kinase) mutations, mucosal melanomas carry mutations or extra copies of KIT (receptor tyrosine kinase) and rarely have BRAF mutations.4 Currently, the recommended treatment for vaginal melanoma is wide local excision with negative margins. Non-surgical management includes radiation therapy, chemotherapy, or both. Radiation after wide local excision has the lowest recurrence rate.3 Interferon-alpha, the only FDA approved adjuvant therapy, has shown to increase recurrence-free survival by 30% but recent studies suggest that interferon- alpha does not improve overall survival.7 For penile melanomas, lesions on the foreskin of the penis may be treated by circumcision but lesions of the glans or shaft call for partial penectomy. In cases of urethral involvement, partial penectomy is recommended for fossa navicularis, urethrectomy penectomy and total urethrectomy with anterior exenteration if the posterior urethra is involved. Scrotal involvement calls for wide local excision. However, these measures were only beneficial for lesions
metastases in the lungs, subcutaneous tissue, stomach and right femur. Given the poor prognosis of metastatic penile melanoma, the patient enrolled in hospice care and is currently alive. Primary vaginal melanoma most commonly afflicts elderly, Caucasian and post-menopausal women while penile melanoma affects men in their fifties and sixties.1,2 Although a higher proportion of melanomas are mucosal in Hispanics, Asians and African Americans (due to the lower incidence of cutaneous melanomas in these populations), the absolute incidence of mucosal melanomas is higher in Caucasians for an unknown reason.5 Ultraviolet light, a risk factor for cutaneous melanoma, is not a risk factor for genital melanoma as the incidence of mucosal melanomas is not increased in southern geographic regions. Human papillomavirus and human herpes virus do not appear to play a role either.6 Of note, recent studies indicate that while cutaneous melanomas frequently carry BRAF (serine/threonine kinase) mutations, mucosal melanomas carry mutations or extra copies of KIT (receptor tyrosine kinase) and rarely have BRAF mutations.4 Currently, the recommended treatment for vaginal melanoma is wide local excision with negative margins. Non-surgical management includes radiation therapy, chemotherapy, or both. Radiation after wide local excision has the lowest recurrence rate.3 Interferon-alpha, the only FDA approved adjuvant therapy, has shown to increase recurrence-free survival by 30% but recent studies suggest that interferon- alpha does not improve overall survival.7 For penile melanomas, lesions on the foreskin of the penis may be treated by circumcision but lesions of the glans or shaft call for partial penectomy. In cases of urethral involvement, partial penectomy is recommended for fossa navicularis, urethrectomy penectomy and total urethrectomy with anterior exenteration if the posterior urethra is involved. Scrotal involvement calls for wide local excision. However, these measures were only beneficial for lesions
