CASE PRESENTATION
A 54-year-old female patient who visited the oncology unit with myalgia,
arthralgia, and fatigue, as well as a palpable mass and pain in the
genital area with foetid transvaginal bleeding that had progressed over
two weeks, reported the following medical history: history of
gynaecology and obstetrics, menarche at 11 years of age, the start of an
active sexual life at 20 years of age, two sexual A prolapse of the
vaginal vault with an ulcerated tumour measuring roughly 10 centimetres,
extending from the proximal third to the distal third, hyperpigmented,
friable, and with transvaginal haemorrhage, was discovered during the
gynaecological examination . When the lesion was biopsied, it revealed
abnormalities in the epithelial cells that were suggestive of melanoma
[Figure 1], melanoma with lymphovascular invasion, with vertical
growth and superficial dissemination, with mucosal ulceration present,
with four mitoses per mm2, and surgical limit of
excision of the vulva in focal contact with the limit. CKAE1/AE3 (+/++),
vimentin (+/+++), CD45 (-) and chromogranin (-), PS-100 ++/+++ (40%),
and HMB45 ++/+++ (40%), were all focally positive according to the
immunohistochemistry report. A thoracoabdominal tomography revealed lung
metastases, a tumour mass in the uterine topography, and multifocal
liver disease with metastasis. With acceptable tolerance, treatment
began with a conservative surgical resection, followed by post-operative
radiation and biological therapy using nivolumab and ipilimumab.