A routine physical examination unexpectedly revealed a potentially life-saving diagnosis for one woman when her primary care physician (PCP) noticed an unusual spot on her labia. The discovery of a labial melanoma at its earliest stage, described as a "freckle" on the skin, highlights the importance of comprehensive physical exams, even for seemingly innocuous findings.
The patient, who was between gynecologists and experiencing postmenopausal symptoms, asked her PCP to perform a pelvic exam and pap smear. During the exam, the PCP noted a strangely shaped gray spot outside the vaginal opening, photographed it, and recommended a dermatology consultation. Although the dermatologist initially expressed low concern, stating "I'm 99% sure it's nothing," a biopsy was performed.
A week later, the patient received a call confirming the spot was melanoma, specifically vulvar melanoma. Her dermatologist explained it was "in situ," meaning it was confined to the top layer of skin. However, the location of vulvar melanomas often means they are not detected until they cause discomfort, bleed, or become a larger mass, by which time they can have spread aggressively to lymph nodes.
According to the surgeon, nearly 40% of vulvar melanoma patients present with regional or metastatic disease, compared to about 13.6% for cutaneous melanomas. Stage III vulvar melanoma has a five-year survival rate of approximately 48%, dropping to 25% for Stage IV. The rarity of vulvar melanoma, which primarily affects white, postmenopausal women, means there is limited research on the condition. Unlike many cutaneous melanomas, there is no definitive link between vulvar melanomas and sun exposure, and they are often asymptomatic.
Navigating the healthcare system to find a surgeon willing to perform the delicate procedure proved challenging. The patient was referred from her dermatologist to gynecology and then to gynecological oncology, with multiple departments hesitant to take on the case due to the unusual location and the required one-centimeter margins for removal. Ultimately, she was referred to a melanoma surgeon specializing in skin cancer, who confirmed she was well-practiced in these types of melanomas and accepted the case.
Surgery to remove the melanoma took over an hour, followed by a few weeks of recovery. The patient's prognosis is excellent, with a less than 3% chance of recurrence, due to the early detection. She will undergo regular check-ups with her surgeon and a dermatologist specializing in vulvar cancer.
The patient emphasized that many postmenopausal women may skip regular pelvic exams or are unsure about their frequency. She advises women to discuss their personal health history and symptoms with their doctors to determine an appropriate schedule. Routine checks by gynecologists or dermatologists for unusual spots, similar to how dentists screen for oral cancer, can potentially lead to earlier detection of vulvar cancers.