Treatment of Genital Melanoma: Are We Ready for Innovative Therapies?

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To the Editors
We read the interesting article of Iacoponi et al1 reporting prognostic factors predicting survival outcomes of patients affected by vulvar melanoma (VM). The authors analyzed data of 42 patients with VM registered in the VULvar CANcer study. They observed important findings: (1) VM is a rare occurrence; (2) VM is characterized by a high recurrence rate; (3) tumor size correlates with local recurrence risk; (4) stage of disease (assessed by the American Joint Committee on Cancer) is associated with metastatic disease at recurrence; and (5) adjuvant treatments do not impact on patients outcomes.1 Recently, our study group reviewed data of 98 patients affected by genital melanoma treated at the IRCCS Foundation, National Cancer Institute of Milan.2 Among those, 67 (68%) had VM.3 In our study, we observed that nodal status is the main prognostic factor driving patients’ prognosis, thus suggesting the importance of lymph node dissection in this cluster of patients.2 Unfortunately, the study from Iacoponi et al1 did not corroborate our results. However, data about lymphadenectomy and lymph node status were not available in a relevant proportion of patients included.1 Therefore, it is not possible to assess the real value of lymph node dissection. In addition, the most important consideration rising after the reading of the present and our articles is the poor survival outcomes of these patients. Further studies are warranted to compare the prognostic and the potentially therapeutic values of sentinel node mapping in comparison with full lymphadenectomy. In the recent years, survival of patients affected by advanced melanoma has been greatly improved thanks to the introduction of new therapeutic strategies. Bevacizumab, BRAF, and MEK inhibitors as well as immunotherapies have shown very encouraging results.2,4,5 Patients with genital melanomas have to be centralized into clinical trials to test innovative therapeutic strategies, especially in the case of advanced or recurrent disease.

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