Vulvar melanoma in an immunocompromised patient: A case report and surgical perspective

Vulvar melanoma is a rare malignancy, accounting for around 10% of vulvar cancers. Management is particularly challenging in patients with complex comorbidities, where immune dysfunction may affect both disease behavior and surgical risk. We report the case of a 65-year-old woman with heart failure, hypertension, diabetes, pulmonary and extrapulmonary tuberculosis on treatment, and treated hepatic abscess who presented with a progressively enlarging vulvar mass. Examination revealed asymmetric hyperpigmented lesions and a 4 cm × 3 cm exophytic lesion on the labia minora. Biopsy confirmed vulvar melanoma. A multidisciplinary team optimized infection control, cardiac and hepatic function, and glycemia before surgery. She underwent a wide local excision with negative margins. Postoperative recovery was uneventful, and she remained disease-free after 6 months of follow-up. This case illustrates the link between immune dysfunction and oncogenesis. It also underscores how strategic surgical intervention, guided by multidisciplinary insight, can achieve meaningful oncologic outcomes even in severely immunocompromised patients.