1. Shiksha, Pallavi Agrawal, K M Prasad, N K Bariar, Geeta Sinha
Departments of Pathology (S, PA, KMP, NKB,), Obstretics and Gyanecology (GS)
Patna Medical College and Hospital Patna
2. Malignant melanoma is a common neoplasm of skin
and mucous membrane
Incidence Female genital tract <2%
Vulva 76.7%
Vagina 19.8%
Cervix 3-9%
Amelanotic 50% of mucosal melanomas
Disease was accepted in 1960 when Cid described
presence of melanotic cells in cervix
3. Awareness of this rare entity to be included in the differential
diagnosis of poorly differentiated carcinomas of cervix
4. 46-year-old postmenopausal woman presented with bleeding
per vagina for past 15 days
She was on treatment of asthma, inhaler SOS
Per vaginal examination revealed a hard polypoidal growth the
root of which could not be reached
Ultrasound abdomen revealed a well defined hypoechoic
cystic lesion involving posteroinferior margin of cervix
She was advised for CECT pelvis and planned for cervical
biopsy
Under Total intravenous anesthesia (TIVA) an enhanced visual
assessment (EVA) was done
EVA revealed a caulifower like growth involving cervix which
was pimented and keratinisation of vaginal mucosa
5. Per rectal examination revealed rectal mucosa free with
involved bilateral parametrium
She was staged as FIGO Stage IIB
Cervical biopsy was done and sent for
histopathological examination
Gross examination revealed already bisected cervical
polypoidal lesion
Microscopy confirmed the diagnosis of malignant
melanoma
Primary MM was confirmed by IHC and exclusion of
other primary sites
She was planned for radical hysterectomy with
adjuvent chemotherapy
6. Cervical epithelium forms complete spectrum of
melanotic lesions from benign lentigenes to blue nevi
to melanoma
Due to rarity of the disease it is staged according to
FIGO staging system rather than the Clark and
Breslow scales as it correlates better with the survival
5 year survival rate
18.8% for stage I
11.1% for stage II
0% for stages III–IV
7. MRI can distinguish between melanoma and other
tumors due to a distinct signal pattern from the
paramagnetic properties of melanin (high signal
intensity on T1-weighted image and low signal
intensity on T2-weighted images)
PAP smear shows bizarre cells with melanin pigment
Etiology is unknown
Risk factors HPV infection/Hormonal influence
8. melanocytes migrate from neural crest to the
uterine cervix
melanocytes differentiate from the endocervical
epithelium
9. presence of melanin in the cervical epithelium
absence of melanoma in another site of the body
Demonstration of junctional change in the cervix
if metastatic disease is found, it should be according
to the cervical carcinoma pattern
10. Lesion Immunohistochemistry
Poorly differentiated SCC p63
Poorly differentiated Adenocarcinoma Pan CK
High grade Lymphoma LCA
Anaplastic carcinoma Pan CK
Stromal sarcoma Vimentin
Rhabdomyosarcoma Myogenin, MyoD1
LMS (D/D with desmoplastic varient) SMA
Blue Nevus (D/D with desmoplastic varient) HMB45, MART1,SOX10
11. Treatment include radical hysterectomy with pelvic
lymph node dissection and partial vaginectomy
followed by radiation therapy, either intracavitary or
external beam radiation or both
C-kit alteration identified in 2006 responded well to
imatinib but still on clinical trial
12. Fig 1 Gross examination showing dark brown
lesion near epithelium and deep cervical stroma
13. Fig 2Melanoma cells invading
cervical stroma reaching close
to epithelium (H&E 40x)
21. Poor prognosis
Aggressive due to local recurrence and extensive
early metastasis
Treatment differs so early diagnosis important to
differentiate from squamous cell carcinoma
Radio-resistant tumor
Due to rarity no consensus have been made on
standard protocol of treatment
Collaborative studies and follow up is recommended
to establish a definite protocol for treatment of such
unfortunate patients
22. Julião I, Carvalho SD, Patricio V, Raimundo A. Primary malignant melanoma of the cervix: a rare disease. BMJ Case Rep.
2017 Apr 21;2017. pii: bcr-2017-219361. doi: 10.1136/bcr-2017-219361.
Noguchi T, Ota N, Mabuchi Y, Yagi S, Minami S, Okuhira H, Yamamoto Y, Nakamura Y, Ino K. A Case of
Malignant Melanoma of the Uterine Cervix with Disseminated Metastases throughout the Vaginal Wall.
Case Rep Obstet Gynecol. 2017;2017:5656340. doi: 10.1155/2017/5656340. Epub 2017 Jan 18.
Gupta M. Malignant melanoma of cervix. BMJ Case Rep. 2016 Nov 28;2016. pii: bcr2016217970. doi: 10.1136/bcr-2016-
217970. PMID: 27895081
Lee JH, Yun J, Seo JW, Bae GE, Lee JW, Kim SW. Primary malignant melanoma of cervix and vagina. Obstet Gynecol Sci.
2016 Sep;59(5):415-20. doi: 10.5468/ogs.2016.59.5.415. Epub 2016 Sep 13.
Lim KH, Tay SK, Ng AX, Mantoo S. Primary Melanoma of the Uterine Cervix: A Case Report, With Key Points on
Recognition and Pathological Diagnosis.J Low Genit Tract Dis. 2017 Jan;21(1):e1-e4. doi:
10.1097/LGT.0000000000000264.
