Metastatic and Synchronous Melanoma in the Testicle and Paratesticular Region

Abstract

Background: Metastatic tumors of the testicles are rare (0.8%) and preferably located in the testicular parenchyma or, much more rarely, in the para-testicular region. The melanoma of the skin represents the third primary site of metastases and the patients may present with increased scrotum volume, heterogeneous testicle mass beside local pain and tenderness. Objective: To show the rare case of metastatic and synchronous melanoma in the testicle and para-testicular region. Description of the case: Case reports of a 74-year-old male patient who was undergone an extended acral melanoma resection in the left calcaneus. The micro stage showed Clark level IV and Breslow depth of 3 mm. The treatment was complemented with homolateral inguinal-iliac lymphadenectomy. Three years later a crossed metastasis was diagnosed in the opposite inguinal region that required another lymphadenectomy. The patient developed a perineal lymphedema that was managed clinically. He was then carried to oncologist who starts high-dose interferon per one year as adjuvant therapy. Two years later, the patient showed an increased size and irregularity of the right testicle along with pain and loss of elasticity. An ultrasound confirmed an increased testicle diameter and increased vascularization associated with parenchyma heterogeneity. The measurements of LDH, alpha-fetoprotein and βHCG were normal. A staging computed tomography scans showed bilateral pulmonary nodules and increased diameter of periaortic lymph nodes representative of metastatic disease. A radical right orchiectomy via the inguinal route was then expedited. The histopathology diagnosed synchronous metastatic melanoma in the testicle and paratesticular region. Conclusion: The presence of a testicular mass in patients with previous clinical history of melanoma represents a warning sign. It should be considered a metastatic disease at first time and an accurate diagnostic restage is mandatory.