Treatment of recurrent vaginal melanoma with external beam radiation therapy and palladium-103 brachytherapy

Background Mucosal melanoma of the female genital tract that recurs locally after definitive surgery presents difficult challenges for salvage therapy. Methods and Materials A 71-year-old female was diagnosed with a 4.5-cm × 4.1-cm × 2.8-cm vaginal recurrence of genital tract mucosal melanoma after definitive vulvectomy, distal vaginectomy, and distal urethrectomy. She refused surgery and underwent combination external beam radiation therapy (46 Gy) and an ultrasound-guided palladium-103 brachytherapy implant (100 Gy). Results The patient experienced complete resolution of the gross tumor and was asymptomatic with a sustained response for over a year before developing metastatic disease. Conclusions Mucosal melanoma of the female genital tract is an aggressive and often fatal disease. Radical surgical excision is an option for some patients but may require pelvic exenteration and is rarely curative. In selected cases, high-dose conformal radiation therapy delivered by a combination of external beam radiation therapy and interstitial brachytherapy may be an excellent alternative, achieving local control without loss of organ function.