Vulvovagal melanoma is a rare type of mucosal melanoma with a high propensity for local spread, regional and distant metastases. Primary treatment is surgery, if feasible without exenterative intervention, with the goal of achieving negative margins of 1-2 cm. Most vaginal melanomas are not amenable to wide local excision because of their proximity to the urethra, bladder, anus, and rectum. For clinically enlarged nodes, lymphadenectomy is considered to improve locoregional control. The five-year survival rate is 58% for vulvar melanoma and 27% for vaginal melanoma. BRAF mutation occurs in 26% of cases, KIT in 22% (higher in vulvar - 31.4% versus vaginal - 6.2%). PD-1 is expressed by 75% of patients and PD-L1 by 56%, suggesting the possibility of immunotherapy. With nivolumab, the median progression-free survival was 14 months with PD-L1 ligands, compared to 11.2 months with combination therapy without them.