Malignant melanoma of the female genital tract diagnosed by cervicovaginal smear: A rare case from the Middle East

Malignant melanoma is a rare form of cancer in the Middle East, and its occurrence, particularly in the female genital tract, is exceptionally uncommon. These tumors often present diagnostic challenges due to their rarity and variable cytomorphological features. We report the case of a 61-year-old postmenopausal woman from a rural region who presented with vaginal bleeding. A routine Papanicolaou (Pap) smear revealed atypical pigmented malignant cells, raising suspicion for melanoma. Histopathological examination of a vaginal wall biopsy, supported by immunohistochemical staining, confirmed the diagnosis of malignant melanoma. The patient underwent total vaginectomy with labia minora resection. Post-operative positron emission tomography showed no residual or metastatic disease. She is currently receiving adjuvant nivolumab and is doing well. To the best of our knowledge, melanoma diagnosed through cervicovaginal Pap smear has been rarely documented in a Middle Eastern woman. This case underscores the critical role of cytological screening and the importance of a broad differential diagnosis for detecting rare malignancies, even in low-incidence regions.