Primary melanoma of the vagina is a rare tumor associated with a poor prognosis. The clinical and pathologic features of 15 patients treated at the University of Michigan Medical Center and Bowman Gray School of Medicine are reviewed. The presenting symptom of bleeding was noted in 80% of the patients. The cumulative 5-year survival was 17.4%. Two patients survived more than 5 years. All melanoma tumors were of the nodular type, 66% were located in the lower one-third of the vagina, and all patients were found to have invasion greater than 3 mm at the time of diagnosis. The majority of recurrences were located in the pelvis, with the lung being the most common metastatic site. Data from the literature were incorporated with these patients' data in a meta-analysis. Tumor thickness (6 mm or less) significantly (P = .015) affected the disease-free interval. Tumor size (less than 3 cm) significantly (P = .024) influenced survival, whereas age, stage, tumor location, and tumor thickness did not. There was no significant difference in survival among patients treated by surgical resection, irradiation, or surgical resection plus irradiation. The type of surgery, whether radical or conservative, also did not influence survival. One patient had a complete response to high-dose irradiation fractions (greater than 400 cGy), and this form of irradiation in conjunction with surgical resection is presented as a treatment option.