Wohlmuth C, et al. - In a large representative cohort, researchers characterized the epidemiology and prognosis of vulvar melanoma (VuM) and vaginal melanoma (VaM). For this investigation, they identified women with invasive VuM or VaM from the Surveillance, Epidemiology and End Results-18 population representing 27.8% of the US population. Information on age, ethnicity, stage, location, histopathology, primary surgery and lymphadenectomy have been gathered. To identify factors with a significant association with disease-specific survival, univariate and multivariate regression models have been used. In total, 1,400 VuM and 463 VaM were involved for further analysis. The most common subtype in VuM and nodular melanoma in VaM was superficial spreading. Findings suggested a significant association of survival with age at diagnosis, ethnicity, stage, surgery, lymph node metastases, histologic subtype, ulceration, mitotic count, and tumor thickness in VuM, and stage, surgery, and lymph node involvement in VaM. VuM and VaM's overall prognosis remains low. The American Joint Committee on Cancer Staging System is applicable and should be used for VuM, but the most important predictors of survival are lymph node status and mitotic rate. Lymph node status should be evaluated and individuals with positive nodes may be candidates for adjuvant treatment.