MALIGNANT melanoma of the penis is a rare occurrence with only 25 cases reported in the literature. Of these, 24 were primary lesions (Wheeloch and Clark, 1943; Reid, 1957; Schneiderman et al., 1965;Sirsat and Shrikande, 1965;Patoria and Junnarkar, 1966), whereas one case was metastatic from the thigh (Paquin and Roland, 1956). Recently, we have had the opportunity to review two primary melanomas of the glans penis, one with a four-and-a-half-year follow-up. Case 1.-A 70-year-old white male was first seen in November 1962 by his local physician. Two months prior t o that time, the patient noticed a "blister" on the left side of the glans penis which healed spontaneously. Shortly thereafter there appeared a vivid red spot which rapidly enlarged and became indurated. No dysuria was noted. Physical examination revealed a 1.5 cm. in diameter, raised, dark, granular lesion, just dorsal and to the left of the external urethral meatus. No palpable masses were found in the groin and the remainder of the physical examination was not remarkable. An excisional biopsy of the lesion revealed a malignant melanoma (Fig. 1). One month later an amputation of the distal 6 cm. of the penile shaft was performed and no residual tumour was found in the surgical specimen.In July 1963 a mass was palpated in the left groin and a left inguinal node dissection was performed, revealing metastatic malignant melanoma. Two years later, metastases to the lungs were evident and in November 1966 the patient developed signs and symptoms of cerebral metastases. Four and a half years after the initial diagnosis the patient died. An autopsy revealed metastatic melanoma in the peri-aortic and tracheo-bronchial lymph nodes, lungs, wall of the stomach and occipital lobe of the brain.Case 2.-A 66-year-old white male consulted his local physician in October 1967 because of the recent onset of gross hEmaturia. The patient had not been able to retract his prepuce for several years, and over the past six months he had experienced a purulent discharge. Pertinent physical findings were limited to the penis where a 1 cm. papillary, brown, granular lesion was located on the right aspect of the glans. No inguinal nodes were palpated. The distal 6 cm. of the penis was amputated and histological examination revealed a malignant melanoma with permeation of the deep lymphatics (Fig. 2). A bilateral groin dissection was recommended; however, the patient refused further surgery. Six months after the initial therapy evidence of metastatic melanoma was found in a lymph node of the left groin.
DISCUSSIONThe most frequent malignancy of the penis is the squamous cell carcinoma which, according to the series of Wheeloch and Clark (1943), is 15 times more common than malignant melanoma. However, in the world literature (Dixon and Moore, 1953), more than 2,500 cases of squamous cell carcinoma have been reported, indicating that this tumour will occur at least 100 times more frequently than malignant melanoma of the penis. Both types of malignancy tend to occur between the four...
