Sarcoma. Melanoma
Sarcoma
Embryonal rhabdomyosarcomas (sarcoma botryoides) occurs almost exclusively in children younger than 5 years old. These children usually have vaginal bleeding or discharge, and grapelike, gray-red masses may protrude from the vagina.
Perioperative chemotherapy (vincristine, dactinomycin, cyclophosphamide) offers a survival advantage with various sarcomas. Thus, instead of exenteration, patients are probably best treated with preoperative combination chemotherapy, followed by tailored surgical management and the possibility of adjuvant radiation for patients with positive surgical margins.
In adults, leiomyosarcomas and mixed miillerian tumors are the most common tumors. As with similar sarcomas of other organs, mitotic counts are important in assessing malignant potential. Surgical excision of these tumor masses, with removal of adjacent organs, is the primary therapy. Adjuvant cisplatin with ifosfamide for mixed miillerian tumors and doxorubicin hydrochloride with or without cisplatin for leiomyosarcomas may prove effective. However, a large number of patients with vaginal sarcomas have not been treated with these agents.
Melanoma
About 150 cases of primary vaginal melanoma have been reported. The average age of patients is about 58, and patients present with bleeding, discharge, or a mass. Dark lesions of the vagina should be excised. These neoplasms most commonly occur in the lower anterior vaginal tube. Survival for this rare malignancy of the vascular vagina is poor: 5-10%.
Radical surgery (radical hysterectomy with radical vagi-nectomy or exenteration) may yield better 2-year survival rates than conservative therapy such as wide excision plus irradiation. Lymphadenectomy, directed against anatomic spread patterns, should be performed with radical surgery. Chemotherapy is of little value.