Primary Melanoma of the Cervix Uteri: A Systematic Review and Meta-Analysis of the Reported Cases

SIMPLE SUMMARY: Melanoma is a malignant cancer mainly affecting the skin, although other unconventional sites have also been reported. In this study, we systematically reviewed the literature to identify cases of malignant melanoma affecting the cervix uteri. Our study included 96 reports, which comprised 137 patients. Our findings revealed that most patients presented with non-specific symptoms, including vaginal bleeding and discharge, and most were postmenopausal. The main therapeutic approach included surgical resection. Even though most patients were diagnosed at early stages, the prognosis was poor. Knowledge regarding the rare occurrence of malignant melanoma in the cervix and the increased awareness of clinicians can prevent misdiagnosis and ultimately improve the outcomes of patients developing this rare malignancy. ABSTRACT: Primary malignant melanoma (MM) of the cervix uteri is a rare and aggressive malignancy of the female reproductive tract. Considering that clinical data on this cancer are scarce, we aimed to comprehensively examine the currently available literature and provide an overview of the reported cases of cervical MM focusing on the clinical characteristics, diagnosis and therapeutic management. We conducted a systematic review of the literature by screening three electronic databases until June 2022. The critical appraisal checklist provided by the Joanna Briggs Institute was employed to evaluate the overall quality of the studies. We included 96 reports, which comprised 137 patients diagnosed with MM of the cervix. The mean age of the patients was 56.5 (median: 58, age range: 33–88). Data regarding menopausal status were provided for 98 patients with 15 being premenopausal and 83 being postmenopausal. The most common presenting symptom was vaginal bleeding (83%, 100/121). Biopsy (either excisional or punch biopsy) was used as the first diagnostic modality in most of the patients (67%, 64/95), followed by cytology (18%, 17/95). In 74 cases, the FIGO staging system for cervical cancer was used with the most common stage being FIGO stage I (38%, 28/74), followed by FIGO stage II (36%, 27/74), FIGO stage III (19%, 14/74) and FIGO stage IV (7%, 5/74). Most of the patients were managed surgically (90%, 119/131) with a hysterectomy (either radical or total), and a salpingo-oophorectomy with/without lymphadenectomy was the most common approach utilized (40%, 48/119). The data of clinical outcomes were provided for 105 patients, of whom 61 died (58%, 61/105) and 44 survived (42%, 44/105). Knowledge regarding the rare occurrence of MM in the cervix and the increased awareness of clinicians can prevent clinical misdiagnosis and ultimately improve further the clinical outcomes of patients developing this rare malignancy.