Hard Vaginal Mass in Young Woman with History of Malignant Melanoma

Case at a Glance

A 23-year-old female with a history of multiple malignant melanomas and recent significant weight loss presents with a newly discovered hard, round mass near the vaginal opening. The patient has complicated menstrual history and is concerned about malignancy recurrence.

Patient's Story

The patient discovered a hard, round mass approximately the size of a gumball located between her urethra and vaginal opening, slightly to the right side. The mass is subcutaneous, firm, and painless. She reports no associated symptoms such as pain, discomfort, or changes in urination. The patient has a complex menstrual history including 12 months of amenorrhea followed by 12 months of irregular bleeding ranging from very heavy to very light. She also reports chronic small bumps on her labia, previously evaluated and determined to be non-infectious, possibly related to contact dermatitis from soaps or detergents.

Initial Assessment

Given the patient's significant oncological history of multiple aggressive malignant melanomas (2019-2022) requiring four wide excisions, any new mass requires careful evaluation. The patient also has a history of bariatric surgery (Roux-en-Y) with recent 100+ pound weight loss, complicated menstrual cycles with low testosterone levels (PCOS ruled out), and current limited access to gynecological care.

The Diagnostic Journey

The patient sought medical advice due to concerns about the new mass, particularly given her cancer history. Initial clinical suspicion includes benign causes such as Bartholin's gland cyst, sebaceous cyst, or other benign gynecological masses. However, given the patient's history of multiple malignant melanomas, malignant transformation or metastatic disease cannot be ruled out without proper evaluation.

Final Diagnosis

Pending gynecological evaluation and possible imaging or biopsy. Differential diagnosis includes benign cysts (Bartholin's, sebaceous, or inclusion cyst) versus malignant lesion requiring histopathological confirmation.

Treatment Plan

Urgent gynecological consultation recommended despite healthcare access limitations. The patient has submitted an appointment request with the hospital's obstetrics and gynecology department. Given her cancer history, expedited evaluation is warranted. Imaging studies and possible biopsy may be required for definitive diagnosis.

Outcome and Follow-up

The patient is awaiting gynecological consultation. Given her history of malignant melanoma and the presence of a new mass, close monitoring and prompt evaluation are essential. The patient has been advised that any new lumps or bumps in someone with a cancer history should be evaluated as a precautionary measure, even when asymptomatic.