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Case Reports
. 2022 Oct 19;24(6):430.
doi: 10.3892/ol.2022.13550. eCollection 2022 Dec.

Primary vaginal malignant melanoma successfully treated with combination therapy: A case report

Ping Yin  1   2   3 , Xiaolin Ma  2   3 , Yanfei Zhang  3   4 , Yang Song  1   2   3 , Yuntao Wang  1   2   3 , Zhong Lu  1   2   3   4
Affiliations
Case Reports

Primary vaginal malignant melanoma successfully treated with combination therapy: A case report

Ping Yin et al. Oncol Lett. .

Abstract

Primary vaginal melanoma is rare compared to cutaneous melanoma, and it has a high rate of invasion and metastasis. The prognosis of tumors is poor and the quality of life of patients is low. In addition to traditional surgical and non-surgical treatment, combined treatments are more effective for patients with distant metastatic melanoma. Due to the high immunogenicity of vaginal malignant melanoma, immunotherapy has become an effective treatment strategy for distant metastatic vaginal melanoma, and with the application of immune checkpoint inhibitors (ICIs), outstanding achievements have been made in the treatment of the disease. Studies have shown that ICIs combined with radiotherapy (RT) or anti-angiogenic therapy can have a synergistic effect in certain tumor treatments, normalizing blood vessels and enhancing immune responses. However, whether ICIs combined with RT and anti-angiogenic therapy can benefit patients with distant metastatic vaginal melanoma remains unclear. The present study reports the clinical case of a patient with distant metastatic vaginal melanoma treated with combined RT, anti-angiogenic therapy and ICIs. The patient's primary tumor and distant metastases improved after combination therapy. The combination therapy successfully improved the patient's prognosis and prolonged the patient's overall survival. This provides a reference for combining all three treatment modalities in the treatment of distant metastatic vaginal melanoma.

Keywords: abscopal effect; anti-angiogenic therapy; combination therapy; immune checkpoint inhibitors; primary vaginal malignant melanoma; radiation therapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
Image before first combination therapy (May 2020). The blue arrow points to the lesion to be evaluated. (A and B) Magnetic resonance imaging showed tumor recurrence in the perineum. The size of the mass was ~9.0×7.2 cm. (C and D) Magnetic resonance imaging revealed multiple metastases in the left adrenal region. The largest was ~2.0×1.3 cm. (E) The gross appearance of the tumor.
Figure 2.
Figure 2.
Diagnosis and treatment process. Red, PD; yellow, SD; green, PR; blue, CR; grey, new metastatic lesions. RT, radiotherapy; PD, progressive disease; SD, stable disease; PR, partial response; CR, complete response.
Figure 3.
Figure 3.
Stable condition of the patient after first combination therapy (August 2020). The blue arrow points to the lesion to be evaluated. (A and B) Magnetic resonance imaging showed that the left perineal mass was significantly smaller than before. The size of the mass was ~3.3×1.4 cm. (C and D) Magnetic resonance imaging showed that the metastases in the left adrenal region were larger than before. The largest was ~2.8×1.2 cm. (E) The gross appearance of the tumor.
Figure 4.
Figure 4.
At 2 months after the first combination therapy, the tumor status was partial response (October 2020). The blue arrow points to the lesion to be evaluated. (A and B) Magnetic resonance imaging showed that the left perineal mass was smaller than before. The size of the mass was ~2.7×1.1 cm. (C and D) Magnetic resonance imaging showed that the largest metastasis in the left adrenal gland was ~1.5×1.0 cm, which was smaller than before. (E) The gross appearance of the tumor.
Figure 5.
Figure 5.
Tumors showed PD at 18 months after the first combination therapy (December 2021). The blue arrow points to the lesion to be evaluated. (A and B) Magnetic resonance imaging showed a left perineal mass, and muscle and soft tissue edema. The size of the mass was ~1.8×0.9 cm. (C and D) Magnetic resonance imaging showed that the largest metastasis in the left adrenal gland was ~5.5×5.2 cm, which was significantly larger than before. (E) The gross appearance of the tumor.
Figure 6.
Figure 6.
Tumor status was PR at 6 months after the second combination therapy (June 2022). The blue arrow points to the lesion to be evaluated. (A and B) Magnetic resonance imaging showed that the left perineal mass was smaller than before, and the soft tissue edema around the perineum was reduced. The size of the mass was ~1.3×0.9 cm. (C and D) Magnetic resonance imaging showed that the largest metastasis in the left adrenal gland was ~3.8×3.7 cm, which was smaller than before. (E) The gross appearance of the tumor.
Figure 7.
Figure 7.
Time course showing the changes in primary and metastatic tumor size. The first and second combinations of immune checkpoint inhibitors, radiotherapy and antiangiogenic therapy were administered in May 2020 and December 2021, respectively. The maximum cross-sectional area of the primary tumor and left adrenal metastases decreased after two combined treatments.
See this image and copyright information in PMC

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