Vulvar melanoma is a rare type of cancer that develops in the skin of your vulva. Early symptoms include a lump or growth, itching, and color changes.

Melanoma is a type of skin cancer. It starts in cells called melanocytes, which produce melanin. Melanoma tends to occur in areas of your body that get a lot of sun exposure. But you can develop melanoma in parts of your body that don’t get much sun.

Mucosal melanoma is a type of melanoma that starts in melanocytes in mucous membranes, such as your vulva. It can also develop in your vagina, your anus and rectum, or your nose, lips, and mouth.

Vulvar melanoma is rare and aggressive. Anyone with a vulva can get it, but it’s most common in postmenopausal women.

Read on to learn more about signs and symptoms of vulvar melanoma and what you can expect of treatment.

Language matters

In this article, we talk about vulvar melanoma in people who are assigned female at birth. It’s important to note that not everyone assigned female at birth identifies with the label “woman.” But at times, we use “woman” to reflect the language in a study or statistic. We also occasionally use “woman” to make sure people can find this article with the terms they search. When possible, we aim to be inclusive and create content that reflects the diversity of our readers.

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Vulvar melanoma originates in the skin of the mucous membranes on your outer female genitalia. Parts of your vulva are:

  • labia majora (larger outer skin folds)
  • labia minora (smaller inner skin folds)
  • clitoris
  • vaginal opening

Vulvar melanomas tend to develop around your clitoris or labia. A lesion can be flat or raised. It’s usually dark brown or black, but could also be other colors, such as red, pink, or white. Some other characteristics include:

  • uneven coloring
  • asymmetrical (nonidentical halves)
  • irregular or blurred edges
  • can start in an existing mole
  • 2–4 millimeters thick (0.07–0.15 inches)
  • often ulcerated (open sore)
  • changing in size, shape, or color

According to the American Cancer Society, about 39,490 women will get a diagnosis of melanoma in 2023. Vulvar cancer represents about 0.7% of all cancers in women, but they’re not all melanomas. Research suggests that only about 1% of all melanomas in women affect their vulva.

Vulvar melanomas are aggressive. And because you might not notice small lesions, vulvar melanoma is often advanced when people receive the diagnosis.

Symptoms of vulvar melanoma may include:

  • lump, lesion (or open sore), or thickening of the skin in your labia
  • color changes on your vulva
  • itching that doesn’t go away
  • unusual discharge
  • bleeding
  • tenderness or pain, especially when touched

A routine pap test screens for cervical cancer but doesn’t detect vulvar melanoma. Regular pelvic exams can help detect vulvar melanoma early. If symptoms arise between visits, don’t wait. Let a doctor or other healthcare professional know right away.

Cancer happens when damaged cells start to grow out of control. It’s well known that exposure to ultraviolet (UV) rays can kick-start this process in cutaneous melanomas (those that develop in the skin). But risk factors for mucosal melanomas (those that develop in mucous membranes) aren’t well established.

Anyone with a vulva can develop vulvar melanoma at any age. But it’s usually diagnosed in postmenopausal women. The median age to receive a diagnosis is 68 years old.

Research suggests that about 85% of people with vulvar melanoma are white and 7.8% are Black. Another 5.4% are Hispanic, and other races make up the rest.

Other risk factors for vulvar melanoma are:

  • family history of melanoma
  • personal history of melanoma in other places
  • personal history of atypical moles (dysplastic nevi) in other areas of your body

A doctor will begin the diagnosis process by performing a physical examination. Because it’s difficult to tell the difference between benign and malignant lesions, you’ll most likely need a biopsy. A biopsy is the only way to confirm a diagnosis of vulvar melanoma.

Because this type of cancer is often advanced when people receive the diagnosis, a doctor will likely order imaging tests, such as CT or PET scans. This will help determine whether the cancer has spread.

A doctor will tailor a treatment plan based on your individual circumstances. The next steps depend on factors such as:

  • how many and where lesions appear on your vulva
  • how deep the lesions are
  • whether they’re ulcerated
  • whether it has reached your lymph nodes
  • the cancer stage
  • your age and overall health
  • your personal preferences

The main treatment for localized melanoma (melanoma that has not spread beyond the vulva) is surgery. A vulvectomy is a procedure in which a surgeon removes all or part of the vulva. In most cases, the surgeon will remove the lesion, plus a wide margin of healthy tissue, if possible.

A pathologist (a scientist who specializes in cell and tissue study) will check this sample to see if the border is clear. If not, you may need more surgery.

Surgery might also include a sentinel lymph node biopsy to see if the cancer has reached your lymph system.

Compared with cutaneous melanoma, there are fewer effective treatment options. In some cases, treatment may include:

Vulvar melanoma is rare, so there’s limited data. Statistics on other types of vulvar cancer or melanoma that start elsewhere on your body don’t translate to vulvar melanoma.

Factors that can affect your outlook include:

  • your age when you receive the diagnosis
  • lymph node involvement
  • the stage of the cancer when you receive the diagnosis
  • tumor size
  • other health conditions (comorbidities)

Research suggests that having surgery and checking regional lymph nodes gives a survival advantage. People with regional and distant metastatic vulvar melanoma (melanoma that has spread beyond the vulva) generally have a poor outlook.

The 5-year overall survival rate for all stages combined is 47%, which may reflect late diagnoses.

The 5-year survival rate for people with negative lymph nodes is 65.2%. That compares with 26.8% for those with positive lymph nodes.

According to a 2021 study, the overall recurrence rate for vulvar cancer is 22.3%.

Keep in mind that studies on this rare cancer are quite limited. These are only general statistics. It’s important to speak with your oncologist (a doctor who specializes in treating people with cancer) about your personal outlook so you can make treatment decisions that are appropriate for you.

Vulvar melanoma is a rare and aggressive type of cancer. It’s easy to miss the symptoms, so it’s often advanced when people receive the diagnosis. Vulvar melanomas are generally dark, irregular, and changing.

The primary treatment is surgery to remove the cancer. There’s limited data, but people with vulvar cancer that has spread beyond their vulva generally have a poor outlook.

Early detection and treatment offer you the best outlook. If you have symptoms of vulvar melanoma, it’s best to see a doctor as soon as possible.