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Forum Name: Lymphoma

Question: Mucosal Melanoma?


 In NeedOfAdvice - Fri Aug 29, 2008 1:38 am

Hello,
I went to my PCP on 08/05 for what seems to be a swolen lymph node in the crease between my peg and pelvis...menstrual irregularity, blood tinged vaginal discharge varying from mucous to thick and white to clear, leg discomfort, pelvic pain, and lesions that have appeared and have spread all around the outside of my vagina opening and up to the clitoris. I had a blueish "dot" seven years ago when I had my son. My OB asked if I had always had it, I didn't know. Within the past year I have noticed it has been spreading. I have read the A,B,C,D rule...The colors are blue, brown, and almost black in some areas...borders are irregular...etc. I have been sexually active with my husband for 7 years since my son was born -without any birth control, and no pregnancies.

My PCP on 08/05 gave me a referal to an Oncologist for biopsies. As of today, my appointment is not until Oct. 1st...which will be 2 months after the initial visit.

Since the PCP visit:
Platelets are up to 575 which are higher than they were when I had surgery for a surgery in June. White cells are also a little higher than normal.
I have a referal to a Hematologist whom I will see next week.
I have also had a pelvic ultrasound done last week which they found bilateral ovarian cysts. I have been told they look to be functional and small.

My PCP asked me if I had had Melanoma before when she saw the lesions at the 08/05 appt. Of course I said "No". She also ordered the Pelvic ultrasound because she felt my uterus was enlarged. Why would my Uterus feel enlarged if I have just 2 small functional cysts?

I guess I am wondering what steps I need to take in order to get someone to listen to me. I am extremely fatigued, have chronic diarrhea, abdominal bloating, chronic leg pressure and leg pain, and ...I have a 7 year old son.

It seems like none of my doctors are talking. I have to reiterate everything and "convince" each one that I do NOT feel well. Everyone of them is making me feel like I am a hypocondriac, but I really FEEL that there is something wrong with me. Is there something I can do to expediate this?
 Dr. Safaa Mahmoud - Fri Oct 10, 2008 6:20 pm

User avatar Hello,

Melanoma is a cancer that develops from pigment producing cells that gives the skin (including the vulva) its color. Melanoma of the vulva although is the second most common invasive cancer occurring in the vulva, its occurrence is rare.

Pigmented lesions on the vulva are considered suspicious if they are blue-black in color, have an irregular border or are larger than 1 cm. Changes in characters of an existing mole is considered suspicious too. Melanoma of the vulva is almost always presents with inguinal lymph node metastases. The only way for diagnosis is by biopsy and pathological examination.

Symptoms of irregular vaginal bleeding, discharge, pelvic pain in addition to the US results of ovarian cysts and endometrial thinking could be related to Polycystic Ovary Syndrome PCOS.

PCOS- is a condition in which females may present with:
-Irregular menstrual cycle, irregular vaginal bleeding, infertility and uterine wall changes up to cancer.
-Excess hormones including insulin production and insulin resistance resulting in type2 diabetes mellitus and abnormal skin pigmentation.
-Excess male hormone (testosterone and androgen) results in (obesity), acne, oily skin, or dandruff and hair loss.
-High blood pressure.
Although skin pigmentation in these cases occurs in different part of the body, the vulva could be part of it.

Another cause that gives similar clinical picture is endometriosis.
Endometriosis is an often painful disorder of the female reproductive system.
In endometriosis, a specialized type of tissue that normally lines the inside of your uterus (the endometrium) becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.
It causes:
-Painful periods (dysmenorrhea).
-Excessive bleeding.
-Pelvic pain.
-Infertility.
Endometriosis of the vulva although confusing with other lesions like nevus, melanoma, hemangiomas, it can be easily diagnosed on histology. The condition is also painful and is though to be caused by direct implantation of endometrial tissue after trauma including delivery.

Another cause of pigmented lesions in the vulva is acanthosis nigrans although rare. Areas of chronic inflammation are more prone to be involved with pigmentation in this condition. Pigmentation in the vulva increases after pregnancy due to higher tendency to inflammation in this area. This is a condition that can be benign or associated with malignancy else where in the body.

The results of your blood test are not so clear for me, however platelets mildly increase in number in individuals who frequently lose blood like excess vaginal bleeding (meno/metrorrhagia).

I agree with your physician that biopsy is essential to exclude melanoma even if other causes seems to be also possible. In general all pigmented lesions in the vulva should be biopsied.

Please keep us updated.
Best regards.

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