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GENITO-URINARY MELANOMAS: CLINICAL FEATURES, PROGNOSTIC FACTORS AND TREATMENT OUTCOMES ANALYSIS OF 1586 CASES.
Dayron Rodríguez, MD MPH, Alejandro Sanchez, MD, Seth K. Bechis, MD MS, Jed-Sian Cheng, MD MPH, Glen W. Barrisford, MD, Mark A. Preston, MD, Adam S. Feldman, MD MPH.
Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND: Experience with management of genito-urinary melanoma is rare. Therefore, in order to better elucidate the disease characteristics of genito-urinary melanoma we utilized a large population-based cancer registry to examine the epidemiology, natural history, pathological characteristics, prognostic factors and treatment outcomes.
MATERIAL AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1973-2010) was used to identify cases by tumor site and histology codes. The association between demographic, clinical, pathological characteristics and long-term disease specific survival (DSS) was examined.
RESULTS: A total of 1586 histologically confirmed cases were identified between 1973 and 2010. The cohort was composed of 77 penile, 35 scrotal, 67 urinary tract, 1059 vulvar and 348 vaginal melanomas. The annual age-adjusted incidence rate was 0.91 cases per 1,000,000, and did not significantly change over time. Median age of the patients was 69 years (range 7-98). Of the patients with a known tumor stage (N = 1224), 40% had a regional or distant stage. Of the patients with known Clark’s level (N = 536), 72% had a Clark level IV or higher. The majority of patients (88.8%) received cancer directed surgery. Only 9.5% of patients received radiation therapy in combination with surgery. The median disease specific survival was 58 months. Overall, five and ten-year cancer specific survival rates were 51% and 42%. For males, 5 and 10-year DSS rates for genital melanomas and urinary tract melanomas were 69% and 58%, and 63% and 31%, respectively (p < 0.04). For females, 5 and 10-year DSS rates for genital melanomas, urinary tract melanomas, and vaginal melanomas, were 58% and 48%, 35% and 29%, and 27% and 18%, respectively (p < 0.001). On univariate analysis, age, sex, race, marital status, stage, anatomic location, Breslow thickness, presence of ulcerations, and lymph node involvement were all significant predictors of survival. On multivariate analysis, a worse outcome was associated with increasing age, Clark level 4 or higher, distant stage, positive lymph node involvement, urinary tract and vaginal locations, and presence of ulcerations.
CONCLUSION: This series represents the largest cohort of genito-urinary melanomas studied to date. Genitourinary melanomas commonly presented with a high Clark level and advanced stage with a poor prognosis. A worse disease specific survival was associated with increasing age, Clark level 4 or higher, distant stage, positive lymph node involvement, urinary tract and vaginal locations, and presence of ulcerations.


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