Women are being cautioned about an uncommon cancer that impacts the vaginal lining after two patients overlooked their symptoms and unfortunately succumbed to the illness.

Doctors in Taiwan highlighted two cases involving a 69-year-old and a 75-year-old woman, where the primary symptom was irregular vaginal bleeding—an anomaly for women of their ages.

Both patients initially dismissed the symptoms until finally going to the hospital where they were diagnosed with cervical melanoma.

Melanomas found in the female genital region constitute approximately three percent of all melanoma cases in women. Most instances of these occur in the vulva or vagina, with cervical melanomas being exceedingly rare.

Medical studies suggest that cervical melanomas account for three to nine percent of female genital melanomas, equating to 0.0009 to 0.0027 percent of melanomas in women overall.

A 2020 review of medical studies noted: ‘Gynecologic melanomas are exceedingly rare cancers, and primary malignant melanoma of the cervix (PMMC) is the rarest among them, with fewer than 100 cases documented to date.’

Along with being ‘exceptionally rare,’ cervical melanomas are highly aggressive and have a poor prognosis. 

There is no standard, agreed-upon treatment and it is hard to diagnose because it usually presents with no symptoms.

These melanomas are not caused by sun exposure. Melanoma starts in cells called melanocytes, the pigment producing cells found mostly in the skin.

Most melanomas develop in parts of the body exposed to the sun. But you can get them anywhere, including body organs, because there are melanocytes in these areas too.

Signs and symptoms of vaginal melanoma may include pain, bleeding or irregular discharge. 

While cervical melanomas have been mostly observed in women post-menopause between 60 and 70, one case study detailed the cancer in a woman who was just 56. 

The five-year survival rate varies from five percent to 25 percent, according to OB-GYN Dr Catherine Tucker, who was not associated with the study. 

In the American Journal of Case Reports, doctors detailed two anonymous women who both had the rare cancer.

The first, a 69-year-old, had experienced one month of ‘massive vaginal bleeding’ but had no feelings of fullness – a common symptom of other cervical cancers – or pain. She did report dizziness and fatigue.  

Doctors performed a transvaginal sonography, a procedure that uses ultrasound waves to obtain detailed images of the female reproductive organs.

It confirmed a cervical mass measuring approximately 7cm and a pelvic mass measuring 2cm.

She was diagnosed with Stage 4 cervical melanoma following a biopsy and further tests that revealed the disease had spread to other areas of her body. 

Despite chemoradiotherapy (a combination of chemotherapy and radiation therapy) and immunotherapy, the disease progressed rapidly, and the patient died four months after diagnosis.

In the second case, the 75-year-old woman also experienced vaginal bleeding for one month. 

She did not experience any other symptoms but she was also suffering from diabetes and Alzheimer’s disease.

Following a pelvic examination, a cervical mass measuring nearly 8cm by 6cm by 1cm was discovered in the vaginal wall.

Doctors noted it had a ‘pigmented appearance’ and a biopsy revealed it was a malignant melanoma.

Chemoradiotherapy was used to shrink the tumor and a hysterectomy (the surgical removal of the uterus and cervix) was performed.

While the initial treatment was successful, the cancer returned 17 months later, prompting more surgery to remove the lesions. 

The disease remained stable for three years but then the irregular vaginal bleeding returned and the patient reported a strange feeling in her bowels.

MRI scans revealed multiple tumors and lesions. Chemoradiotherapy was initiated but later discontinued due to poor patient tolerance.

The female patient was subsequently transferred to hospice care, where she died seven years after her initial diagnosis.

In their report, the doctors say that selecting the best course of treatment was ‘particularly challenging due to the absence of standardized guidelines for cervical melanoma’. 

However, from the two female patients they treated, they found that surgical intervention was the best course of action and it is ‘associated with improved survival outcomes’. 

The researchers concluded: ‘Further research is needed to develop standardized treatment protocols. 

‘Raising awareness among clinicians and improving early diagnostic strategies are also crucial to enhancing survival rates and quality of life for patients with this rare and challenging malignancy.’