{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T01:00:46Z","timestamp":1768006846946,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Primary mucosal melanomas of the female genital tract account for one percent or less of all cases of melanoma with even fewer originating in the clitoris. Given the rarity of diagnosis of clitoral melanoma, there is a paucity of data guiding management. There is no supporting evidence that radical vulvectomy (with or without inguinal lymphadenopathy) is associated with improved disease-free or overall survival compared to partial vulvectomy or wide local excision. Additionally, there is no data to evaluate the role of sentinel lymph node biopsy or extensive lymphadenectomy in clitoral melanoma, however previous evidence demonstrates the utility of regional lymph node sampling in predicting survival in women with female genital tract mucosal melanoma. Adjuvant therapy considerations are often extrapolated from their use in treating cutaneous melanomas, including immune checkpoint inhibitors and other immunotherapy agents. Adjuvant radiation therapy has limited utility except in cases of bulky, unresectable disease, or when inguinal lymph nodes are positive for metastasis. The 52 year-old patient presented in this review was diagnosed with locally invasive advanced stage clitoral melanoma presenting as an exophytic clitoral mass. She underwent diagnostic primary tumor resection, which demonstrated ulcerative melanoma with spindle cell features extending to a Breslow depth of at least 28 mm. She subsequently underwent secondary wide local excision with groin sentinel lymph node biopsy, and adjuvant treatment with pembrolizumab. This article also emphasizes the importance of a multidisciplinary team involving gynecologic oncology, medical oncology, radiology, and pathology for management of this rare type of primary mucosal melanoma of the female genital tract.<\/jats:p>","DOI":"10.3390\/curroncol28060362","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T14:37:48Z","timestamp":1634827068000},"page":"4264-4272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Management of Clitoral Melanoma Presenting as an Exophytic Clitoral Mass: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6371-206X","authenticated-orcid":false,"given":"Alec","family":"Szlachta-McGinn","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bartosz","family":"Chmielowski","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuna","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Raman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Urology, and Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanaz","family":"Memarzadeh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"UCLA Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"UCLA Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"The VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s11912-019-0843-x","article-title":"Primary Melanoma: From History to Actual Debates","volume":"21","author":"Testori","year":"2019","journal-title":"Curr. Oncol. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"MMT11","DOI":"10.2217\/mmt-2018-0003","article-title":"Combatting mucosal melanoma: Recent advances and future perspectives","volume":"5","author":"Tyrrell","year":"2018","journal-title":"Melanoma Manag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ctrv.2018.12.005","article-title":"Vulvar malignant melanoma: Pathogenesis, clinical behaviour and management: Review of the literature","volume":"73","author":"Boer","year":"2019","journal-title":"Cancer Treat Rev."},{"key":"ref_4","unstructured":"National Comprehensive Cancer Network (2021, May 12). Head and Neck Cancers. (Version 3.2021). Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/head-and-neck.pdf."},{"key":"ref_5","unstructured":"National Comprehensive Cancer Network (2021, May 12). Cutaneous Melanomas. (Version 2.2021). Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/cutaneous_melanoma.pdf."},{"key":"ref_6","unstructured":"National Comprehensive Cancer Network (2021, May 12). Vulvar Cancer. (Version 3.2021). Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/vulvar.pdf."},{"key":"ref_7","first-page":"e4530","article-title":"Stage Two Malignant Melanoma of the Clitoris: A Case Report","volume":"11","author":"White","year":"2019","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/j.1365-4632.2007.03123.x","article-title":"Melanoma clitoridis","volume":"46","author":"Ettler","year":"2007","journal-title":"Int. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/00000658-199402000-00003","article-title":"Surgical management of regional lymph nodes in patients with melanoma. Experience with 4682 patients","volume":"219","author":"Slingluff","year":"1994","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1007\/s00330-015-3992-9","article-title":"Metastatic patterns and metastatic sites in mucosal melanoma: A retrospective study","volume":"26","author":"Mann","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mervic, L. (2012). Time course and pattern of metastasis of cutaneous melanoma differ between men and women. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0032955"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ygyno.2006.03.010","article-title":"Patterns and frequency of recurrences of squamous cell carcinoma of the vulva","volume":"103","author":"Woolderink","year":"2006","journal-title":"Gynecol Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2626","DOI":"10.1002\/1097-0142(19940515)73:10<2626::AID-CNCR2820731026>3.0.CO;2-U","article-title":"Malignant melanoma of the vulva treated by radical hemivulvectomy. A prospective study of the Gynecologic Oncology Group","volume":"73","author":"Phillips","year":"1994","journal-title":"Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.3802\/jgo.2020.31.e66","article-title":"Vulvar melanoma: An analysis of prognostic factors and treatment patterns","volume":"31","author":"Albert","year":"2020","journal-title":"J. Gynecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s40257-019-00487-x","article-title":"Malignant Melanoma of the Vulva and Vagina: A US Population-Based Study of 1863 Patients","volume":"21","author":"Wohlmuth","year":"2020","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/1346-8138.12921","article-title":"Malignant melanoma on female clitoris with bidirectional upper and lower lymphatic flow","volume":"42","author":"Takahashi","year":"2015","journal-title":"J. Dermatol."},{"key":"ref_17","first-page":"4017","article-title":"Primary malignant melanomas of the female lower genital tract: Clinicopathological characteristics and management","volume":"10","author":"Wang","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/j.1525-1438.2007.00885.x","article-title":"Utility of sentinel node biopsy in vulvar and vaginal melanoma: Report of two cases and review of the literature","volume":"17","author":"Dhar","year":"2007","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/0090-8258(92)90300-8","article-title":"Management of vulvar melanoma","volume":"45","author":"Trimble","year":"1992","journal-title":"Gynecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/0002-9378(88)90493-0","article-title":"Conservative therapy for melanoma of the vulva","volume":"159","author":"Rose","year":"1988","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1006\/gyno.2001.6337","article-title":"Vulvar melanoma: A retrospective analysis and literature review","volume":"83","author":"Irvin","year":"2001","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/S0002-9378(98)70320-5","article-title":"Primary vaginal melanoma: Thirteen-year disease-free survival after wide local excision and review of recent literature","volume":"178","author":"Buchanan","year":"1998","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/BF02524343","article-title":"Primary vaginal melanoma: A critical analysis of therapy","volume":"11","author":"Miner","year":"2004","journal-title":"Ann. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15003","DOI":"10.1038\/nrdp.2015.3","article-title":"Melanoma","volume":"1","author":"Schadendorf","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1758835920922028","DOI":"10.1177\/1758835920922028","article-title":"Immune checkpoint inhibitors in advanced or metastatic mucosal melanoma: A systematic review","volume":"12","author":"Li","year":"2020","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1470-2045(08)70254-7","article-title":"Management of primary melanoma of the female urogenital tract","volume":"9","author":"Piura","year":"2008","journal-title":"Lancet Oncol."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/28\/6\/362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:19:46Z","timestamp":1760167186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/28\/6\/362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["curroncol28060362"],"URL":"https:\/\/doi.org\/10.3390\/curroncol28060362","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,21]]}}}