Melanoma of glans penis and urethra: A case report and systematic review of the literature of a rare and complex neoplasm

Abstract

Objective: To evaluate the features and prognosis of melanoma of glans penis and urethra, with the presentation of a significant case report. Materials and methods: A systematic literature review was performed using the MEDLINE (PubMed) and Cochrane Libraries databases to identify all cases of male mucosal melanoma reported. Results: Two hundred fifty-two patients with male mucosal primary melanoma were found. Glans penis and fossa navicularis as primary site includes the 81.6% of all lesions considered. Median Breslow’s depth is 2.1 mm, whereas nine in situ melanomas have been reported. At the diagnosis, the disease was at a non-localized stage in 21.4% for glans penis melanomas and 11.7% urethral lesions, respectively. The 2 and 5-year survival for glans melanoma is 62.5% and 38.4%; higher rates were observed in the 2012–2020 period (76% and 58.8%, respectively). Two-year survival for urethral melanomas is 66.7%, while 5-year survival is 12.5%. 22 patients survived over 5 years with a Breslow’s depth reported always < 3.3 mm. Conclusion: Melanoma of the glans penis and urethra is a rare neoplasm associated with a poor prognosis, however recent reports show higher survival rates. Surgery remains the mainstay for a localized disease. Taking into account the small number of cases reported, topical imiquimod seems to be a valid non-surgical alterative for melanoma in situ. The use of immunotherapy and targeted therapy should be considered only in an adjuvant setting according to the recommendations of cutaneous melanoma; however, additional clinical data on male mucosal melanoma are needed to draw definitive conclusions.

Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas

“…As for the mucosal melanoma of other sites, primary mucosal melanoma is at high risk of local and distant relapse, and a close follow-up is recommended, especially in the first 3 years [ 119 ]. Unfortunately, the are no studies of adjuvant systemic therapy including more than one patient with penile mucosal melanoma [ 119 , 121 ]. A proposed flowchart for the management of PMM is provided in Figure 2 .…”

Giant penile melanoma

“…край резекции должен быть подобран индивидуально с учётом функциональных и анатомических особенностей генитальной области [3]. В нашем случае даже несмотря на обширность поражения удалось добиться отрицательного хирургического края и сохранить небольшую культю полового члена.…”

“…Первичная меланома полового членаредкое новообразование, насчитывающее менее 0,1% всех меланом [1,2]. В мировой литературе зарегистрировано около 250 подобных случаев [3]. Из-за редкости заболевания каждый новый случай, появляющийся в литературе, полезен при определении лечебной тактики и её эффективности.…”

“…наиболее частая локализация -головка полового члена (59,4%), затем уретра (32,3%), препуций и уздечка полового члена (8,3%). Средний возраст пациентов составляет 64 года [3].…”

“…Меланома головки может проявляться в виде бесформенных макулярных поражений или узелков с неоднородными цветом (от синего, коричневого, чёрного до амеланотического), часто наблюдается изъязвление. дифференциальная диагностика проводится с меланозом, меланоцитарными невусами, подслизистым некрозом, лимфомами, ангиокератомами [3].…”