Citation: BJOG: An International Journal of Obstetrics and Gynaecology. 2012, 119, 180
Author: Myagerimath R.; Kubwalo B.; Gul N.
Abstract: Introduction: Melanoma is a tumour of the melanocytes of the skin and mucous membranes. Only 2.5% of cutaneous melanomas metastasise to the female genital tract, the most frequently affected organs being the ovaries. The uterus, mainly the myometrium, is only involved in 10% of cases of genital metastases. The endometrium is less frequently involved 1. Uterine metastases of extra genital malignomas are rarely
presented in literature. Here we are presenting a case of postmenopausal bleeding secondary to metastatic malignant melanoma. Case report: A 58 years old woman presented with postmenopausal bleeding. She had a history of cutaneous melanoma >4 mm excised 2 year earlier followed by brain metastasis treated by craniotomy, excision of right temporal brain metastasis and radiotherapy for 6 months prior to Hysteroscopy
revealed suspicious endometrium and histology reported malignant melanoma. Further imaging ruled out other systemic involvement. After multidisciplinary meeting she was offered palliative laparoscopic hysterectomy BSO, washings and peritoneal biopsy. Histology confirmed metastatic malignant melanoma with positive peritoneal washings. She recovered well without evidence of recurrence and is asymptomatic for more than a year. Discussion: Although genital tract malignancies are a common causes of the postmenopausal bleeding next to atrophic vaginitis, metastatic extra genital malignancies should be considered in a woman with past history of extra genital malignancies. In the index case, palliative surgery was offered for de-bulking and symptom control. Lifetime risk of a woman in the UK developing melanoma is 1 in 117. Melanoma confined to the epidermis is effectively curable and thin lesions carry a >98% 5-year survival rate. However patients with primary tumours of >4 mm thickness have a <50% 5 year survival rate and the median survival for disseminated melanoma is just 7-8 months. The prognosis for patients with advanced visceral metastatic melanoma is particularly poor with a 5-year survival of 5-14% 2. Early diagnosis and appropriate management can improve the survival rate. Conclusion: Abnormal uterine bleeding in patients with a history of malignancy should always alert the physician to consider the diagnosis of metastatic spread to the genital tract.
