Penile Melanoma Research Articles

The clinical and dermatoscopic features of penile pigmentation in men with genital lichen sclerosus

AbstractBackgroundBenign male genital pigmentation is a confusing field with poorly defined terminology. This entity is frequently encountered in our male genital lichen sclerosus (MGLSc) cohort and suggests an association with prior inflammation, however there is a limited literature on the topic.ObjectivesThis paper describes the attributes of 21 patients with MGLSc and features of benign genital pigmentation, reviews the existing literature on benign male genital pigmentation and makes recommendations for better practice.MethodsWe prospectively identified 21 patients with MGLSc and clinical diagnoses of benign penile pigmentation who attended specialist male genital dermatoses clinics. Relevant findings were abstracted from clinical notes, outpatient letters, medical photographs, dermatoscopic images and histological reports.ResultsThe clinical features of this cohort are discussed and the dermatoscopic images analysed. 15 of 21 patients were followed up for over 2 years and all of these had stable appearance of pigmentation. 87% reported pigmentation to have emerged after the onset of MGLSc symptoms, with latency ranging from one to over 25 years. The terms lentiginosis, melanosis, and post‐inflammatory hyperpigmentation are discussed in context of the existing literature.ConclusionsWe propose that genital lentiginosis and melanosis are clinically indistinguishable macroscopically and are on a clinical and histopathological spectrum. Although there is a compelling narrative that genital melanosis is most often truly benign, there is also emerging evidence to suggest an increased risk of penile melanoma in patients with MGLSc. Furthermore, pigmented lesions in MGLSc can portray concerning morphological features even when benign. A low threshold for biopsy and follow‐up is thus warranted.

Primary vulval melanoma and genital lichen sclerosus.

Lichen sclerosus (LS) is a chronic, inflammatory skin disease with a predilection for the genitalia. Although, the association between squamous cell cancer and genital LS is well established, a link with genital melanoma has not been thoroughly explored. However, we have recently published a case series of penile melanoma where 9/11 (82%) of patients seen over a 10year period with penile melanoma were retrospectively found to have histological and/or clinical evidence of genital LS on review. The aim of this study was to illuminate further the relationship between vulval melanoma and genital LS by reviewing all the cases managed by our hospital and undertaking a literature review. We identified all the cases with a diagnosis of vulval melanoma over a 16-year period (2006-2022) where histology was available. The clinical notes were retrospectively reviewed, and the histological features of all cases were reassessed by two independent mutually 'blinded' histopathologists. We also performed a literature review of genital LS in patients with vulval melanoma. A total of 11 patients with vulval melanoma were identified for the review. Histopathological review found evidence of genital LS in seven of them (64%). Genital LS was not documented in any of the original histology reports. Clinical notes and letters were available in nine cases. The literature review identified 12 relevant studies with a total of 18 patients. Twelve cases concerned adult women, and six concerned female children. The presence of genital LS in as high as 64% of our vulval melanoma cases might indicate a causative relationship between genital LS and vulval melanoma. The pathogenesis of vulval melanoma remains largely unknown. Although ultraviolet radiation is an important pathogenic factor for cutaneous melanoma, it cannot be a factor in vulval melanoma. While possible mechanisms behind this association remain unclear, it is possible that chronic inflammation from genital LS leads to melanocytic distress and increased mutagenesis.

Epidemiology and clinical management of primary penile melanoma: A review of the National Cancer Database.

e21570 Background: Primary penile melanoma (PPM) is an exceedingly rare variant of skin cancer, estimated to account for less than 0.18% of all melanomas. As the incidence of melanoma is projected to increase, it is crucial to further understand subtypes of melanoma like PPM. We sought to use the National Cancer Database (NCDB) to describe the epidemiology, clinical features, and treatment modalities of PPM. Methods: We conducted a retrospective review of adults diagnosed with malignant PPM between 2004 and 2021 using the NCDB. Demographic factors analyzed included age, year of diagnosis, insurance status, and facility type. Clinical features studied included regional lymph node examination and treatments. SPSS was utilized to calculate descriptive statistics and chi-square tests for differences between categorical variables. Results: A total of 137 patients met inclusion criteria. The median age at diagnosis was 73 years. The majority of patients were insured by Medicare (n = 86, 63%) or private insurance (n = 46, 34%). About 50% (n = 69) of patients received care at an academic institution with other popular care centers being comprehensive community cancer centers (n = 33, 24%) and integrated network cancer programs (n = 28, 20%). Of the 91 (66%) patients examined for regional lymph node metastasis, 46% (n = 42/91) tested positive. The treatments of choice were partial amputation (n = 70, 51%), excisional biopsy (n = 30, 22%), total amputation (n = 15, 11%), and local excision (n = 10, 7%). After surgical intervention, 74% of patients (n = 101) showed no residual margins. Immunotherapy treatment, which was typically used as an adjuvant (n = 21,15%), increased from 7% (n = 5) of 68 cases diagnosed between 2004 and 2012 to 32% (n = 22) of 69 cases diagnosed between 2013 and 2021 (p < 0.001). Only 7% (n = 9) of patients underwent chemotherapy. Conclusions: To our knowledge, we present the largest study of PPM. Most patients were of older age, covered by Medicare, and examined for regional lymph node metastasis. In line with existing literature that demonstrates increased adoption of organ-sparing procedures over more aggressive approaches for PPM, partial amputation and excisional biopsy were the most common treatments. We observed a rise in the utilization of immunotherapy in the last decade, which is consistent with the timeline of FDA approval of several immune-based therapies for advanced melanoma. Current literature regarding immunotherapy in penile melanoma is scarce. Further research should investigate patient survival and the impact of different treatment modalities on outcomes.

Clinicopathological and Molecular Features of Penile Melanoma With a Proposed Staging System.

Penile melanomas (PM) are an exceedingly rare subtype of mucosal melanoma (MM), and we reviewed the clinicopathologic features and molecular profile in 8 PMs. The patient ages ranged from 46 to 78 (mean: 62.8) years with involvement on the glans (n=5; 62.5%), penile urethra (n=2; 25%), and foreskin (n=1, 12.5%). Tumor depth ranged from 1.6 to 10.0 (mean: 5.25) mm. Most of the patients underwent partial penectomy (n=6; 75%) and sentinel lymph node (LN) biopsy N=7; 87.5%). Seven patients had metastatic disease at diagnosis, 6 involving LNs and 1 the adrenal gland, and 4 died of disease with a mean follow-up period of 40.5 (2 to 95) months. Five of 7 (71%) cases identified 15 molecular alterations within KIT , CDKN2A , NF1 , PTEN , and APC (n=2 each), and NRAS , MAP3K1 , CDH1 , MSH6 , and TERT (n=1 each). Two cases were not found to harbor genetic aberrations, and 1 case failed testing. In addition, we reviewed the English literature and included 93 cases with a reported depth of invasion and follow-up. A total of 101 PMs were analyzed for prognostic parameters, and the overall survival was significantly worse in patients with LN metastasis (P=0.0008), distant metastasis (P=0.0016), and greater depth of invasion (P=0.0222) based upon T-stage. While T4 conferred substantially worse survival, the delineation of the survival curves between T2 and T3 was less clear, and combining T2+T3 disease had a strong prognostic impact ( P =0.0024). Prognostic parameters used in the staging of cutaneous melanomas may also be used in PMs. An alternative staging system expanding the inclusion criteria for T2 might provide a more accurate prognostic stratification.

Penile melanoma: a pathological report of two cases

BackgroundPenile melanoma (PM) is a rare tumor, accounting for less than 2% of all penile cancers. PM can occur on the surface of the glans, foreskin, and opening of the urethra. Furthermore, PM primarily affects older individuals and is not associated with sun exposure. Currently, there is no specific staging system for genitourinary tract melanomas, so these tumors are typically staged using the criteria for cutaneous melanoma. Limited data in the literature suggests that PM generally has a poor clinical prognosis.Case presentationHere, we describe two cases of PM. The first case affected a 62-year-old male who presented with hematuria and a painful tumor in the distal urethra, leading to a suspicion of penile cancer. The second case involved a 68-year-old male who noticed a rapidly evolving dark spot on his foreskin. Histological analysis confirmed the presence of melanoma in both patients. The tumors showed a diffuse and strong PRAME-positivity and lacked BRAF mutation in both cases. Additionally, the second tumor harbored an activating CKIT mutation. An enhanced PD-L1 expression was observed in both tumors.ConclusionsWe presented two rare forms of mucosal melanoma and highlighted the entities in the differential diagnosis. Based on our experience PRAME is a helpful marker for making the diagnosis of PM, and PD-L1 can predict the success of the immunotherapy. We also emphasize the need for an organ-specific staging system for PMs.

Penile melanoma diagnosis aided by in vivo confocal microscopy

Penile melanoma diagnosis aided by in vivo confocal microscopy

Giant penile melanoma

Primary penile melanoma is an extremely rare casuistic pathology associated with a poor prognosis. The article presents a clinical case of massive lesion of the penis with malignant melanoma, and discusses surgical methods for treating this pathology.

A Malignant Melanoma of the Penile : A Very Rare Case Report and Literature Review

Background: Malignant melanoma of the penis is very rare, accounting for approximately 1.4% of all primary penile carcinomas. With a small prevalence of penile melanoma, there is lack of data about quality of the therapy. The primary treatment of melanoma of the penile is surgical, although there is a lack of consensus regarding the extent of treatment that is indicated.
 Case Report: A 60-year-old Caucasian man came to Division of Urology, Department of Surgery, Dr. Kariadi General Hospital Semarang with chief complaint painless and fast growing lesions on his penile. His general condition was fine, and has a normal vital signs. On the physical examination of penile region, there were found lesions on the ventral of the glans and penile foreskin and covered with blood and pus, with bilateral inguinal lymph nodes and lung metastasis from Multi Slice Computed Tomography. We already performed partial penectomy and bilateral inguinal lymph nodes dissection with histopathological results a malignant melanoma Clark IV. The final stage of penile melanoma was pT2N1M1. We follow-up the patient until 1 year after procedure, and there wasn’t any recurrence.
 Conclusion: Malignant melanoma of the penis is rare. Penile melanoma is highly treatable with surgical excision in its early stages because of resistant to both chemotherapy and radiotherapy. Delay in diagnosed and surgical treatment can lead to an adverse prognosis. The anamnesis, physical examination, and imaging studies must be done appropriately to improve the survival.

Response to Imatinib in a Patient with Double-mutant KIT Metastatic Penile Melanoma.

Response to Imatinib in a Patient with Double-mutant KIT Metastatic Penile Melanoma.

A population-level analysis of nonsquamous penile cancer: The importance of histology

BackgroundNonsquamous penile cancers comprise 5% of penile malignancies, though their clinicopathologic features and prognostic significance remain unknown. We used a national cancer registry to detail clinical characteristics and compare cancer-specific mortality (CSM) of nonsquamous cancers with squamous cell carcinoma (SCC). MethodsThe Surveillance, Epidemiology, and End Results (SEER) database (1975–2016) was queried to identify adults with nonsquamous penile cancer and penile SCC. Multivariable Fine and Gray competing-risks regression, propensity score matching, and cumulative incidence plots were used. Results666 men with nonsquamous penile cancer and 5,894 men with penile SCC were identified. The most commonly represented nonsquamous histological subtypes were Kaposi sarcoma (n = 183, 27.5%), melanoma (n = 74, 11.1%), basal cell carcinoma (n = 65, 9.8%), and extramammary Paget disease (n = 42, 6.3%). Cumulative incidence plots revealed a 10-year CSM rate of 32.6% in the nonsquamous penile cancer group and 25.6% in the matched penile SCC group (P < 0.0001). Among Kaposi sarcoma patients and matched SCC patients, we found a 10-year CSM rate of 29.6% in the Kaposi sarcoma group and 15.3% in the penile SCC group (P = 0.002). Similarly, a comparison of penile melanoma patients with matched SCC patients revealed a 10-year CSM rate of 38.4% in the melanoma group and 16.6% in the SCC group (P = 0.002). There was no difference in CSM between patients with basal cell carcinoma and SCC. In a sensitivity analysis limiting year of diagnosis to 2000 and onward, we found no difference in CSM between the general nonsquamous cohort or the Kaposi sarcoma cohort and matched SCC patients, but contemporary melanoma patients maintained worse CSM with a 10-year rate of 38.4% vs. 15.8% in matched SCC patients (P = 0.045). ConclusionsThe most common nonsquamous penile cancers are Kaposi sarcoma, melanoma, and basal cell carcinoma. Overall, CSM is higher in nonsquamous penile cancers as compared to stage-matched SCC. Outcomes are similar in modern patients, likely due to improved control of systemic HIV in patients with Kaposi sarcoma. However, men with penile melanoma continue to experience a higher rate of CSM.

Penile Melanoma In Situ: Long Term Follow Up

Penile melanoma in situ is extremely rare. Various treatments have been reported with good success, however follow up is generally limited to 1 year or less. The optimal treatment regimen, pattern of disease progression and utility of sentinel lymph node biopsy are not established. We provide the longest reported follow up for penile malignant melanoma in-situ, highlighting a long-term pattern of recurrence and a route of progression which does not follow more reliable patterns of lymphatic spread known to penile squamous cell carcinoma. A cautious approach should be taken for organ-sparing approaches along with proper patient counseling and close, long-term follow-up.

Melanoma peniano

Penile melanoma is a rare event, responsible for less than 1.4% of penile cancers. In general, it is late diagnosed and the treatment is usually aggressive. The authors present a 66-year-old Caucasian man who had an ulcerated penile lesion for 1 year, diagnosed as melanoma after biopsy and treated as locally advanced disease with partial penectomy, identification of the sentinel lymph node and bilateral inguinal lymphadenectomy.

The Tip of the Iceberg: A Case of Treated Penile Melanoma With Gastric Recurrence

The Tip of the Iceberg: A Case of Treated Penile Melanoma With Gastric Recurrence

Systematic Review of Surgical Treatment and Outcomes After Local Surgery of Primary Cutaneous Melanomas of the Penis and Scrotum.

Few data exist to guide surgical management and counseling about local recurrence after surgery of primary male genital melanoma. To compile all available data on local recurrence rates after surgery of primary cutaneous melanoma of the penis and scrotum. A systematic review of PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Excerpta Medica database (EMBASE), and Web of Science identified all surgically treated penile and scrotal melanomas that reported local recurrence status and follow-up time. One hundred twenty-seven melanomas from 74 manuscripts were included. Eighty-six percent of melanomas were located on the penis, and 14% were located on the scrotum. Average follow-up time was 35.7 months. Scrotal melanomas were predominantly treated with organ-sparing surgeries (16/18, 88.9%), whereas penile melanomas were treated more often with amputation (61/109, 56.0%). Overall, local recurrence rate was 15.7% (20/127). Local recurrence rates for penile cases were 18.8% (9/48) after organ-sparing surgery versus 13.1% (8/61) for amputative surgery. Local recurrence rates were 66.7% (4/6) after positive surgical margins versus 10.2% (5/49) after negative surgical margins. Local recurrence rates are high after both organ-sparing and amputative surgery of primary cutaneous melanoma of the penis and scrotum. There is a need to standardize reporting for this rare tumor, as more complete data are necessary to develop consensus guidelines for surgical management of male genital melanoma.

The possible role of the da Vinci robot for patients with vulval carcinoma undergoing inguinal lymph node dissection.

Inguinal lymph node dissection represents the gold standard of treatment for patients with vulval carcinoma. The application of minimally invasive techniques, such as robotics, in the surgical treatment of gynecologic cancer, reduced the rate of postoperative complications, which has an important impact on the quality of patients’ life. Robotic inguinal lymph node dissection is a safe and oncologically effective but expensive and time-consuming approach in patients with penile cancer or melanoma. However, it is related with less postoperative complications, especially less lymphocele or lymphedema rates, and can improve the patients’ quality of life while minimizing cost for health systems. The introduction of robot- assisted inguinal lymph node dissection in the treatment of vulval carcinoma may be identified as a provisional option for the gynecologic oncologist. Our intention was to present a brief review/commentary on the possible use of a robot-assisted technique on inguinal lymphadenectomy for patients with vulval cancer.

Penile primary melanoma: analysis of 6 patients treated at Brazilian national cancer institute in the last eight years

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.

Modified endoscopic left inguinal lymphadenectomy

IntroductionEndoscopic inguinal lymphadenectomy is an evolution of laparoscopic surgery thanks to background in these techniques. This is a new technique and the indications in the field of penile tumors today are expanding. The technique aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. Material and methodsWe present the modified endoscopic inguinal lymphadenectomy in a 70-year-old male patient with penile melanoma and positive sentinel lymph node in left inguinal limb. Intraoperative data, pathology, post operatory evolution and oncological follow-up are described. ResultsOperative time was 120min. Nine lymph nodes were retrieved and none of them showed positivity at pathology. There were no complications. The drain was kept for five days. After 12 months of follow up, no signs of disease progression were noted. ConclusionThe endoscopic inguinal lymphadenectomy is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological efficacy and possible lower morbidity of this new approach.

Linfadenectomía inguinal izquierda endoscópica modificada

IntroductionEndoscopic Inguinal Lymphadenectomy is an evolution of laparoscopic surgery thanks to background in these techniques. This is a new technique and the indications in the field of penile tumors today are expanding. The technique aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. Material and methodsWe present the modified endoscopic inguinal lymphadenectomy in a 70 years-old male patient with penile melanoma and positive sentinel lymph node in left inguinal limb. Intraoperative data, pathology, post operatory evolution and oncological follow-up is described ResultsOperative time was 120minutes. Nine lymph nodes were retrieved and none of then showed positivity at pathology. There were no complications. The drain was kept for five days. After 12 months of follow up, no signs of disease progression were noted. ConclusionThe endoscopic inguinal lymphadenectomy is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological efficacy and possible lower morbidity of these new approach.

Amelanotic penile melanoma: A case report and review of the literature

Amelanotic penile melanoma: A case report and review of the literature

448. Local Excision and Brachytherapy for Primary Penile Melanoma – a Case Report

448. Local Excision and Brachytherapy for Primary Penile Melanoma – a Case Report