Modern Management of Newly Diagnosed Vulvovaginal Melanoma

Vulvovaginal melanomas are rare cancers of the vulva and vagina that are often treated similarly despite important differences. Furthermore, although these melanomas are generally considered mucosal, due to their rarity and limited clinical trial data and level I evidence they are often treated with cutaneous melanoma strategies. Resection of the tumor, with or without lymph node assessment, is the preferred primary treatment approach for these cancers. Breslow thickness is a main determinant of surgical approach, and a negative excision margin should be the goal, if possible, without pelvic exenteration. The advent of targeted therapies and immunotherapies has led to new standards in the adjuvant setting, with potential in the neoadjuvant setting as well; however, there is a strong need for mucosal and vulvovaginal melanoma–specific trials and data to guide treatment, and trial participation should be recommended for all patients with these cancers.