NEW YORK - Regular examination of the vulva for skin cancer may be indicated for women with at least one first- or second-degree relative with melanoma.
However, in a small pilot study, only one out of seven dermatologists surveyed reported always examining the vulvar on routine examinations.
In a poster presented at the annual meeting of the American College of Mohs Surgery, Dr. Michael Krathen and Dr. Daniel S. Loo of the dermatology department at Tufts Medical Center in Boston, surveyed 13 attending gynecologists and dermatologists recruited from both Tufts and the Boston Medical Center.
Among the gynecologists, 12 of 13 responded that they "agree or agree strongly that the diagnosis of vulvar melanoma is their responsibility," although 11 of 13 agreed that it is the coresponsibility of the dermatologist to diagnose vulvar melanoma.
Meanwhile, among the dermatologists, only one out of the seven agreed with the statement that they "always" examine the vulva on routine annular exams; four said they do "sometimes," and two stated that they do so "often."
Dr. Krathen and Dr. Loo also examined the charts of 10 patients with malignant melanoma (MM) diagnoses and 3 patients who had malignant melanoma in situ (MMIS).
"The medical charts reviewed were almost all from Tufts," said Dr. Krathen in an interview. "Only one case of vulvar melanoma was identified from Boston Medical Center, perhaps because of the greater diversity in racial groups served by this hospital."
For the MM patients, the average depth of invasion was 4.1 mm, the mean age was 69 years, and at least seven were white. Two of the patients had a brother with MM. Five cases presented as persistent bleeding, itching, or as a "nonhealing erosion."
Looking at the MMIS patients, the average age was 24 years. One case had a second-degree relative with a MM history. Only one of the three presented to the gynecologist specifically because of the melanoma (after becoming concerned about pigment change); the other two presented complaining of dysmenorrheal and abdominal pain, and the lesion was discovered incidentally.
"The standard of care should be to offer examination of the external genitalia in all patients, especially those with a family history of malignant melanoma," said Dr. Krathen.
"Furthermore, reminding female patients to self-examine this area with a hand-held mirror and to ensure that their gynecologist examines the external genitalia during regular examinations is recommended as well."
Dr. Loo and Dr. Krathen reported having no disclosures.