Vaginal melanoma (VM) is a rare disease comprising <1% of all melanomas among women, and about 3% of all vaginal malignancies. Patients experience a poor prognosis, showing <15% 5-year survival. The report concerns two premenopausal patients with VM treated by surgery with radical intent. The first patient presented with a large lesion also infiltrating the proximal paracolpium and the bladder. The second patient had a persistent lesion of the lower third of the vagina. However, in the absence of any evidence-based guidelines or even clear suggestions from the literature, it is reasonable to believe that an appropriate management of primary malignant VM should address the radical tumor resection with wide tumor-free surgical margins and symptom relief.