Primary melanoma of the penis

Abstract

Clinical case: A 54-year-old man had an unremarkable past medical history and was evaluated due to lower urinary tract symptoms. He presented with phimosis and a hard lesion was palpated in the glans penis. A dorsal slit of the foreskin was performed, revealing a black, warty tumor of stony-hard consistency.  Treatment was total penectomy. There was hepatic, splenic, and left inguinal lymph node tumor progression, as well as blastic lesions at the L4, T7, and T9 levels. Temozolomide was the initial palliative treatment, followed by interferon alpha-2b and zoledronic acid.  The patient died 16 months after diagnosis

Relevance: Melanoma of the penis is an aggressive, rapidly progressing, malignant cutaneous neoplasia, with a high mortality rate, that derives from atypical melanocytic proliferation. It accounts for less than 1% of the cases of penile cancer and less than 0.2% of all melanomas. Approximately 200 cases have been reported in the literature.

Clinical implications: Treatment is surgical, through total penectomy, but there is no standardized management. The most reasonable treatment option appears to be radical surgery, when possible, together with adjuvant therapy.

Conclusions: Malignant melanoma of the penis is a cutaneous tumor of poor prognosis, given its great capacity to produce metastases, especially through lymphatic dissemination. Chemotherapy and radiotherapy are only palliative or adjuvant treatments and offer varying results.