Primary malignant melanoma of the uterine cervix: a case report of aggressive progression despite multimodal therapy.

[OBJECTIVE] Primary malignant melanoma of the uterine cervix is an exceptionally rare malignancy with a biology distinct from its cutaneous counterpart and a dire prognosis. This case provides a critical model for interrogating the therapeutic resistance mechanisms inherent to mucosal melanomas.

[METHODS] We report a case of a 73-year-old woman with early-stage (pT1aN0), NRAS Q61K-mutant primary cervical melanoma.

[RESULTS] The patient progressed rapidly through radical surgery and adjuvant Toripalimab (anti-PD-1) immunotherapy. Despite salvage therapy with a MEK inhibitor, she succumbed to the disease 17 months after diagnosis. The sequential failure of both immune checkpoint blockade and targeted pathway inhibition highlights a dual-layer of resistance.

[CONCLUSIONS] This experience mandates a fundamental re-evaluation of adjuvant strategies for this disease. It provides a compelling rationale for upfront, biology-driven combination trials (e.g., immunotherapy plus MEK or CDK4/6 inhibition) in the neoadjuvant or adjuvant setting for high-risk cases.