IASO: Pioneering in Vaginal Melanoma Surgery
For the first time at IASO Hospital, an innovative combined sentinel lymph node detection technique was applied for a rare malignant vaginal neoplasm, increasing diagnostic accuracy and reducing the complications associated with complete lymphadenectomy, by Mr. Theodoros Panoskaltsis, MD, PhD, FRCOG, CCST (UK), ESGO, ESPSO, Gynecologic Oncologist, Associate Professor at the National and Kapodistrian University of Athens (NKUA), Director of the Gynecologic Oncology Center of IASO Hospital.
The patient detected a painless dark-colored mass measuring 3 × 3 cm at the vaginal opening. Due to the high likelihood of a primary melanoma, she immediately underwent a PET/CT scan (PET/CT Department, IASO Hospital, Director: Mr. Vasilis Prasopoulos), which revealed no other pathological foci. On the day of admission, in collaboration with Ms. Kalliopi Vonorta, Director of the Nuclear Medicine Department of IASO General Clinic, a local injection of Technetium-99m sulfur colloid was administered, followed by sentinel lymph node mapping in the inguinal regions, and the surgical procedure was performed under general anesthesia two hours later. Initially, a local injection of Indocyanine Green (ICG) dye was administered to confirm the exact position of the sentinel lymph nodes, as previously located by the Nuclear Medicine Department. Through small bilateral inguinal incisions and using the combined technique described above, the sentinel lymph nodes were identified and removed. This was followed by radical excision of the tumor with confirmation of clear surgical margins. Frozen-section biopsy confirmed the diagnosis of melanoma, completely excised with tumor-free margins. Despite the extensive removal of nearly half of the vaginal mucosa, primary closure allowed the full restoration of normal vaginal anatomy.
With an excellent postoperative course, the patient was discharged on the second postoperative day. The final histological examination confirmed the complete removal of the melanoma and sentinel lymph nodes which were negative for metastasis. The use of modern technical means at our hospital enabled the safe detection and removal of only the sentinel lymph nodes, avoiding complete bilateral Inguinofemoral lymphadenectomy, minimizing the risk of serious postoperative complications (primarily lower-limb lymphedema), and marking significant progress in the safe, minimally invasive surgical treatment of such rare gynecologic tumors.
