Primary malignant vaginal melanoma is a rare vaginal tumour accompanied by an extremely high risk of local recurrence, distant metastasis and a small survival rate. Due to the fact that vaginal melanoma is quite uncommon there is lack of powerful prospective studies in the literature, thus the treatment choice remains controversial. An 85-year-old woman with a primary malignant vaginal melanoma located on the left lateral aspect of the distal vagina, with the greatest diameter almost 5 cm, was referred to our clinic. There was not any sign of local or distant metastasis identified. According to the most recently published data in the international literature, we decided along with the patient to perform conservative dissection of the tumor with free surgical margins as the appropriate mode of therapy. Radiotherapy, chemotherapy or radical extirpation cannot increase the survival time, even if there is a local or distant spread of melanoma.