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.