Abstract
To describe our experience in treating penile melanoma in 06 patients followed at our institution. Between 2004 and 2012 six consecutive patients with penile melanoma were treated at our Institution. Stage of the disease was classified according to the 2002 AJCC pathologic system. Melanoma in situ (TIS) was diagnosed in one patient. One patient was staged as T1b, two patients as T2b and two patients as T4b. The clinical and pathological findings were evaluated. Immunohistochemical tests were performed for Melan-A, HNB-45, S-100 and C-KIT. All histological specimens were examined by the same pathologist (ABSS). The patients with Cis, stages T1b and one patient T2b underwent only local excision. One patient T2b underwent local excision and sentinel lymph node dissection. Two patients with melanoma stage T4b underwent partial penile amputation. One of these last patients had palpable inguinal lymph nodes at diagnosis and underwent bilateral inguinal lymphadenectomy and received systemic chemotherapy (dacarbazine, 30 cycles). Mean follow-up was 36.3 months. One patient, with stage T2b, died after 12 months due to disease recurrence with bilateral inguinal involvement. The patient who underwent chemotherapy progressed with lung metastases and died after 14 months of follow up. The disease-free survival at five years was 33.3%. Penile melanoma is a disease with poor prognosis in most cases. Local excision or partial penile amputation may have effective control for stages T1 and T2 lesions. Patients who have clinically proven metastases died despite surgical and adjuvant chemotherapy.
Highlights
The first case of penile melanoma was described by Muchison in 1859 and the first report of melanoma of the urethra was made by Tirell in 1871 [1]
The lesion is located on the glans (55%), followed by foreskin (28%), penile shaft (9%) and urethral meatus (8%) [4].The involvement of urinary tract mucosa ibju | Penile primary melanoma is more common in females and the explanation is the higher concentration of melanocytes in the mucocutaneous border of the vulva [5]
Given the rarity of the disease, we report our experience with the treatment of six patients with penile melanoma between 2004 and 2012
Summary
The first case of penile melanoma was described by Muchison in 1859 and the first report of melanoma of the urethra was made by Tirell in 1871 [1]. Primary penile melanoma and in male urethra are rare malignant neoplasms that mostly affects elderly patients, from the sixth and seventh decades of life [2]. There are approximately 200 cases described in the literature, representing less than 1.4% of primary carcinomas of the penis [3]. Despite its benign behavior, melanosis can, at times, share features with malignant melanoma as asymmetry, irregular borders, multifocality, variegated pigmentary patterns and large size. Due to late diagnosis and lack of well established treatment protocols, the prognosis is generally poor. It is an aggressive disease, it is possible to maximize cure with treatment in its early stages
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