133th Interinstitute conference
Gynaecologic Oncology unit, Department of Obstetrics and Gynaecology
Srinagarind Hospital, Khon Kaen University
A 76-year-old Thai woman
Hometown: Kalasin province
Payment: Universal coverage scheme
Palpable mass at vulvar for 3 months PTA
3 months PTA, she palpated painless vulvar mass at left side of vulva. The lesion, situated on the left upper labia minora, had black-colored.
1 month PTA, she complained of increased in the size of vulvar mass and the mass developed superficial ulceration. She underwent tissue biopsy and the result suggested malignant melanoma.
The patient reported no other abnormal vaginal bleeding or vaginal discharge.
She has normal appetite and no weight loss.
Underlying of essential hypertension
Current medication: Amlodipine (5) 1x1 p.o. p.c.
No history of food & drug allergy
No history of previous surgery
Obstetrics and Gynecologic history:
G5P4013, last child 36 years
Menopause at 53-year-old
No history of cancer in family
No smoking & alcohol drinking
V/S: BT 37 °C, PR 80/min, BP 131/73 mmHg, RR 16/min
BW: 60.1 kg, HT 150 cm, BMI 26.7 kg/m2
GA: Good consciousness
HEENT: Not pale conjunctivae, anicteric sclerae
CVS: Audible S1, S2, no murmur
Lungs: Equal breath sounds, no adventitious sound
Breasts: Impalpable mass
Abdomen: Soft, not tender, impalpable mass
Liver and spleen impalpable
Lymph node: No supraclavicular and groin node enlargement
Extremities: No edema
MIUB: Black color mass of 3x1.5 cm on left upper half of labia minora
Presented superficial ulceration
Non tender, not fixed to the deeper tissue and firm in consistency
Vagina: Atrophic mucosa, no lesion
Cervix: Os closed, no lesion
Uterus: Normal size
Adnexa: No mass
Cul-de sac: Free
No rectal shelf
Smooth RV septum
What is the appropriate management?
- Metastatic work-up
- Surgical management (Vulva and groin lymph node)
- Role of adjuvant treatment