symptoms of vulvar melanoma, early symptoms and signs of vulvar melanoma
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Symptoms of vulvar melanoma
Early symptoms: Although vulvar melanoma can be found asymptomatic and occasional physical examination, its most common chief complaint is vulvar mass.
Late symptoms: vulvar bleeding or itching, vulvar ulcer, dysuria, pain, headache and weight loss are less common.
Related symptoms: ulcer pain, pubic mass, dysuria, itching and weight loss
The symptoms of vulvar melanoma are similar to other vulvar malignant tumors, Although vulvar melanoma can be found asymptomatic and accidental physical examination, But the most common chief complaint is vulvar mass. Followed by vulvar bleeding or itching, Vulvar ulcer, Dysuria, Pain, headaches and weight loss are less common, These symptoms often appear in patients with advanced stage, If the groin may be swollen due to tumor metastasis in the late stage of the disease, Some patients with pre-existing nevus have nevus enlargement and other changes. Rafnarsson-Olding reported 198 cases of vulvar melanoma, 34.8% of them had vulvar bleeding symptoms, 28.3% had vulvar mass history, 15.2% and 13.6% felt vulvar pruritus and burning stimulation, 12.1% and 10.6% of them felt urination discomfort and vaginal drainage respectively, and the incidence of ulcer, pain and local blackening was less than 5%.
Staging of vulvar melanoma:
1. Clinical staging
The earliest and simplest staging system, stage I: the tumor is confined to vulva with or without satellite focus within 2cm from the primary focus, stage II: the tumor spreads to regional lymph nodes, including skin or subcutaneous nodules more than 2cm from the primary tumor metastasis and located within the lymph drainage of the original focus area, and stage III: the tumor metastasis exceeds the regional lymph nodes.
2. FIGO staging and TNM staging
3. Microscopic staging
In 1969, Clark reported malignant melanoma to dermal papillary layer, The invasion degree of reticular layer and subcutaneous fat layer, The prognosis of patients involved is different, Put forward five levels of infringement, In 1970, Breslow proposed the product of tumor thickness (measured on the section with the deepest infiltration) and the longest diameter of tumor to estimate the prognosis. Melanoma is also divided into five grades, that is to say, Clark is graded according to the anatomical markers of skin and Breslow is graded according to the invasion thickness of tumor. However, due to the lack of well-defined dermal papilla in the skin of vulva and labia, Chung et al. put forward Breslow improved grading, Clark grading, Breslow grading and chung grading system.
1. Clinical manifestations
According to the history, symptoms and signs of melanoma, it is not difficult to obtain a preliminary diagnosis of vulvar melanoma.
2. Histological diagnosis basis
Histopathological diagnosis is necessary for melanoma, and preliminary screening can be carried out by direct smear cytology examination of simple lesions before operation to assist early diagnosis. Small skin lesions should be excised in a circumferential shape. Pay attention to the fact that the excised edge should be 0.5 ~ 3cm away from the surrounding normal skin, with some subcutaneous tissues, so as to determine the whole thickness of the lesions. For large lesions, a full-thickness biopsy specimen can be obtained by using Keys puncb. Radical surgery should be prepared for biopsy or biopsy, and the obtained specimens should be frozen for disease examination immediately and quickly. To any vulvar pigmentation sex lesion contraindication does arbitrarily the local live excision, causes the tumor to spread artificially and impels the tumor to metastasize.
3. Immunohistochemical staining
The diagnosis of malignant melanoma is not difficult according to the characteristics of irregular skin lesions, diversity of cell morphology and tissue structure, and powdery melanin granules between cells. For minimal pigmented melanoma, it must be differentiated from poorly differentiated squamous cell carcinoma, adenocarcinoma and fibrosarcoma.
4. Electron microscopic observation and tissue culture
HMB-45 negative minimal pigmented melanoma was observed by electron microscope. Promelanosomes and some ultrastructural features of melanoma were observed in tumor cells, which was convenient for diagnosis and differential diagnosis. Melanoma without pigment can also produce melanin by tissue culture.
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