[Vulvar melanoma: report of on case and review of litteraure]

The vulvar melanoma is a rare tumour, whose prognosis is bad, related to an often late diagnosis. He accounts for 1,3 to 2,3% of the whole of the melanoma and 8 to 10% of the malignant affections of the vulva. We report the observation of a 46 years old patient, without particular pathological past history. This patient presented a vulvar pigmented lesion which increased volume measuring 2 cm. Initially, local excision of the tumour was carried out and the anatomopathologic study had shown a nodular malignant melanoma with spindle-shaped cells. A thoracic tomodensitometry produced within the framework of the assessment of extension was normal. The surgery consisted of a right hemivulvectomy without inguinofemaral lymphadenectomy. The anatomopathologic study objectified only a surface chrOnic dermite without tumoral hearth. No auxiliary treatment was managed. 1 patient is in local control of her disease with a 24 months passing. The vulvar melanoma is of type SSM [superficiel spreading melanoma] in the 2/3 of the cases and occurs on preexistent naevus in 5% of the cases. The principal prognosis factor is the number of ganglion invaded, from where the interest of the analysis of the ganglion sentinel. The rate of survival depends on the in-depth tumoral infiltration and in surface. The 5-year survival rate ranges from 8 to 62% with a mean of 36%, thus confirming the bad forecast of this affection

[Ungual melanoma: a case report]

Ungual melanoma is a relatively rare disease with reported incidence between 0,7% to 3,5% of all melanoma cases in the general population. Diagnosis is often delayed, due to the difficulty caused by the misleading clinical symptoms. Achromic ungual melanoma remains a exceptional entity. We report the observation of a 70 years old patient who presented a ungual melanoma of the fifth finger revealed by metastasis axillary nodes. Amputation of the last phalanx was carried out and an adjuvant hormonotherapy containing Tamoxifene 20 mg/j was prescribed for 36 months. The patient is in control of her disease with a 5 years passing. Delayed diagnosis and locally advanced stage of the disease at presentation contributed to the poor prognosis in ungual melanoma. Surgery is the basi of the treatement: amputation of the distal phalanx of the hand preserve function and do not compromise survival or local control

[Inaugural metastasis: report of 133 cases]

The malignant tumours are revealed by metastases in 5 to 10% of the cases. Their prognosis is overall bad

Purpose of the study: analysis of the elements of the inaugural metastases diagnostic management and the treatment of the metastatics cancers of unknown primary site

Material and method: at the center of oncology Ibn Rochd, during 2 years [January 2002 - December 2003], 133 patients [2,5%] consulted because of first metastases without obvious signes of primitive. The main metastatic sites were the liver [23%], the lung and/or the pleura [22%], the bone [21%] and the brain [18%]. The search of a primitive has been realized in 52 % of the cases. The other patients had bad general status or lost to follow-up after the first consultation. The clinical investigation permitted to find the primitive in 72,5% of the cases. A specific treatment has been started in 49 patients [37%] ; it consisted in a chemotherapy in 42 cases, a radiotherapy in 2 cases and an hormonotherapy in 5 cases

Result: the response to the treatment has been characterized by complete recovery in 6 cases [recession: 14 months], partial response 50% in 4 cases, 22 patients have been lost to follow-up during the treatment. Twenty mine patients benefitted from symptomatic treatment [radiotherapy] only. The metastatic sites in the patients in complete recovery are the isolate cervicosupraclavicular adenopathies and the metastases of chemo and/or hormonosensible cancer

Conclusion: The unknown primitive metastatic cancers are heterogenous group, that the management is difficult. Their prognosis is still bad with median survival of 8 months and less than 15 % of survivors until 12 months

Malignant paraganglioma of the organ of Zukerkandl

The authors report the case of a patient operated on 1999 because of a paraganglioma of the Zukerkandl's organ. The diagnosis of the paraganglioma has been based on the analysis of the resected piece. Thirty-one months later, she developed medullar compression. The diagnosis of the malignant paraganglioma is confirmed in front of the presence on cromaffin tissue at the level of the affected vertebra. This case illustrates the diagnostic difficulty of this type of tumour before surgery as well as to establish immediate prognosis of this affection. The authors emphasise in this occasion the necessity of a prolonged supervision in order to screen the superview of recurrence or metastases in this localisation known to be malignant in more than the half of the cases