Penile Melanoma Research Articles

Clinicopathological and molecular study of penile melanoma

AimsTo examine the clinicopathological features of a series of penile melanomas and screen for mutations in the BRAF and KIT genes, which are seen in melanomas from other sites.Methods and...

KIT Pathway Alterations in Mucosal Melanomas of the Vulva and Other Sites

A significant proportion of mucosal melanomas contain alterations in KIT. The aim of this study was to characterize the pattern of KIT, NRAS, and BRAF mutations in mucosal melanomas at specific sites and to assess activation of the KIT downstream RAF/MEK/extracellular signal-regulated kinase (ERK) and phosphoinositide 3-kinase (PI3K)/AKT pathways in mucosal melanoma specimens. Seventy-one primary mucosal melanomas from various sites were studied. Mutation analysis was done by DNA sequencing. Expression of KIT, phosphorylated (p)-ERK, and p-AKT was evaluated by immunohistochemistry. KIT mutations were detected in 35% (8 of 23) of vulvar, 9% (2 of 22) of anorectal, 7% (1 of 14) of nasal cavity, and 20% (1 of 5) of penile melanomas. No KIT mutations were found in 7 vaginal melanomas. The difference in KIT mutation frequency between vulvar and nonvulvar cases was statistically significant (P = 0.014). The overall frequencies of NRAS and BRAF mutations were 10% and 6%, respectively. Notably, vaginal melanomas showed a NRAS mutation rate of 43%. KIT gene amplification (≥4 copies), as assessed by quantitative real-time PCR, was observed in 19% of cases. KIT expression was associated with KIT mutation status (P < 0.001) and was more common in vulvar than nonvulvar tumors (P = 0.016). Expression of p-ERK and p-AKT was observed in 42% and 59% of tumors, respectively, and occurred irrespective of KIT/NRAS/BRAF mutation status. NRAS mutation was associated with worse overall survival in univariate analysis. Results show that KIT mutations are more common in vulvar melanomas than other types of mucosal melanomas and that both the RAF/MEK/ERK and PI3K/AKT pathways are activated in mucosal melanoma specimens.

Melanoma of the Penis: A Clinical Dermoscopic Case Study

© 2010 The Authors. doi: 10.2340/00015555-0705 Journal Compilation © 2010 Acta Dermato-Venereologica. ISSN 0001-5555 Sir, Mucosal melanoma is an extremely rare malignancy that comprises less than 4% of all melanomas and accounts for less than 2% of all primary penile malignant lesions (1, 2). It is most frequently located on the glans (55%), followed by the prepuce (28%), penile shaft (9%) and urethral meatus (8%) (3). Penile melanoma is a disease of the elderly: median age at diagnosis is 64 years. By contrast, the average age of patients with cutaneous melanoma is younger (40–50 years of age) (1, 4, 5). The 2and 5-year overall survival rates are 63% and 31%, respectively (1). Compared with tumours occurring in cutaneous sites, mucosal melanomas are often thicker: the median depth of invasion at diagnosis is around 3.5 mm, with approximately 50% of cases thicker than 4 mm (4). A problem in clinical practice is recognizing a pigmented penile lesion as a melanoma. Indeed, one of the major mimickers of mucosal melanoma, and thus of penile melanomas, is melanosis. Clinically, despite its benign behaviour, melanosis can, at times, share features with malignant melanoma: asymmetry, irregular borders, multifocality, variegated pigmentary patterns and large size (6). Dermoscopy may prove useful for the differential diagnosis between mucosal melanosis, and other mimickers, and early melanoma. However, its potential role has been limited so far because little is known about the dermoscopic features of penile melanoma (7). We report here a case of a penile melanoma whose dermoscopic features have been investigated.

Melanoma of the penis with scintigraphically-guided sentinel node biopsy

Melanoma of the penis is an uncommon cancer. We present the case of a 73-year-old male with penile melanoma and non palpable lymph nodes. Lymphoscintigraphy was applied to locate the sentinel lymph nodes for dissection. His lymph nodes were negative for melanoma and he has been disease-free for 1 year with careful surveillance.

Fatal delayed presentation of primary melanoma of the penis

A 60-year-old man presented with a 3-week history of lethargy, anorexia, breathlessness at rest, nausea and vomiting. He had a 5-year history of an undisclosed, enlarging, pigmented mass on his penis. He refused biopsy of this lesion. Fine-needle aspirate of an enlarged inguinal lymph node histologically confirmed a diagnosis of melanoma and widespread metastases were demonstrated by radiological imaging. The patient succumbed to disease within 8 days of diagnosis. Primary penile melanoma, albeit rare, is an important and sensitive dermatological problem, often leading to delayed presentation.

Recurrent Malignant Melanoma of the Penis

We report the case of a 72-year-old man with arcal-lentiginous type melanoma of the penis who had undergone local excision and bilateral inguinal lymphadenectomy but developed recurrence at the subcoronal ridge of the glans penis. To our knowledge, this is the 10th reported case in English published studies. We believe this case demonstrates the importance of close follow-up postoperatively and to beware of the recurrence of penile melanoma in patients without total penectomy.

Prognosis of Primary Mucosal Penile Melanoma: A Series of 19 Dutch Patients and 47 Patients from the Literature

To analyze the clinical features, prognostic factors, and survival of male patients with primary mucosal melanoma on the glans penis, meatus, fossa navicularis, and distal urethra. We analyzed the clinical features, prognostic factors, and survival of 66 male patients with primary mucosal melanoma on the glans penis, meatus, fossa navicularis, and distal urethra diagnosed over the past 25 years. Data from our series of 19 patients were combined with those of 47 patients reported in the literature. The overall 2 and 5-year survival rates were 63% and 31%, respectively. All patients with nodal and/or distant metastases at presentation died within 2 years. Presence of ulceration, tumor depth of 3.5 mm or more, and tumor diameter greater than 15 mm had a significantly adverse effect on prognosis. The prognosis of primary mucosal penile melanoma is not worse than that for cutaneous melanoma with comparable tumor thickness. Treatment should be similar to that for cutaneous melanoma, with wide radical excision and sentinel node biopsy in clinically lymph node-negative patients.

MELANOMA OF THE PENIS, SCROTUM AND MALE URETHRA: A 40-YEAR SINGLE INSTITUTION EXPERIENCE

Genitourinary melanoma is rare and classically associated with a poor prognosis. We describe our experience with 10 patients with penile or urethral involvement. In addition, we present what is to our knowledge the largest reported series of melanoma of the scrotum (6 cases). We reviewed the records of 16 men who presented consecutively to our institution with genitourinary melanoma between 1962 and 2000. Clinical and pathological characteristics were assessed, including Breslow thickness, primary surgical intervention and clinical course. Of 10 patients with penile or urethral melanoma 1997 American Joint Committee on Cancer melanoma pathological stage was T1 (depth less than 0.75 mm) in 4, T2 (0.75 to 1.5 mm) in 3 and T3 (1.51 to 4 mm) in 3. Only 1 of 4 patients with clinically palpable inguinal nodes had inguinal metastases at lymphadenectomy (BILND) and 3 who underwent prophylactic superficial BILND had negative findings. In 7 patients with T1-2N0M0 disease there were no local recurrences after wide local excision (WLE) or partial penectomy at a median followup of 35 months. Six of 7 men were rendered disease-free. One patient died of melanoma that developed at a second primary site. The 3 patients with T3 tumors who underwent partial (2) or radical (1) penectomy with or without BILND died of disease (2) or had progression (1). In all patients with penile melanoma the 5-year actuarial disease specific and recurrence-free survival rates were 80% and 60%, respectively, at a median followup of 39 months (range 20 to 210). Six patients with scrotal melanoma were treated with WLE without local recurrences. Three of the 6 patients had palpable inguinal nodes, of whom 2 died after chemotherapy for unresectable disease and 1 died of other causes 51 months after negative BILND. The 3 men with clinically negative groins who did not undergo prophylactic BILND had distant (1) or regional (2) metastases and died of disease. In patients with scrotal melanoma the 5-year actuarial disease specific and recurrence-free survival rates were 33.3% and 33.3%, respectively, at a median followup of 36 months. Partial penectomy or WLE provided effective local control for low stage penile or urethral melanomas and all scrotal lesions. Patients showing clinically positive, proven metastasis died despite appropriate surgical procedures and multi-agent chemotherapy. Prophylactic modified inguinal lymphadenectomy should be considered in select patients with penile, scrotal and anterior urethral melanoma.

Mélanomes du pénis : 6 cas

Melanomas of the penis are rare tumors of poor prognosis. Six cases of melanoma of the penis, followed between 1975 and 2002, were retrospectively reviewed. We collected the data on epidemiological, clinical and pathologic factors, treatment and follow-up. The mean age was 44 years. The time to diagnosis was 2 years. Two patients had general predisposing factors for melanoma, and 3 patients local predisposing factors. Two patients had partial penectomy and 4 patients had conservative excision. One patient had local recurrence, and another had metastatic course resulting in death. Five patients out of 6 were alive and disease free at time of the study, with a 24 month follow-up. The identified risk factors for the development of penile melanoma are melanosis and pre-existing nevus. Delayed diagnosis explains the usually bad prognosis. Classical surgical treatment used to be radical, but recently, conservative surgery has been proposed. For an early diagnosis, genital melanosis requires surgical excision, when technically feasible, and any atypical lesion of the penis should be submitted to a biopsy.

Melanoma de pene: caso clínico

Penile melanoma is a very uncommon neoplasm, being reported less than 60 cases. Event yet itoutlines not few doubts about its diagnosis and treatment, and in advanced stages represents a challengefor the future since it prognosis is awful at short time. In the present article, its presented aglans melanoma diagnosed and treated at our Service. We make a brief revision of the literature andsome basic issues on the management of this entity when it´s localized in penis, since in the cases in which it extends far from this organ is yet oncological field

Lymphatic mapping and intraoperative lymphoscintigraphy for identifying the sentinel node in penile tumors

Lymph node mapping has become an integral part of the management of melanoma and breast cancer with regard to both staging and treatment. We report our technique for lymphatic mapping and intraoperative lymphoscintigraphy applied to a patient with penile melanoma. This technique may improve the sensitivity of identifying the sentinel lymph node in patients with malignant penile lesions.

Laparoscopic pelvic lymphadenectomy – early results

To report our initial experience and early results of laparoscopic pelvic lymphadenectomy (LPL). Between May 1991 and April 1992, 10 patients with genitourinary malignancy (eight prostate, one bladder carcinoma, one penile melanoma) underwent LPL. Following biopsy, initial staging was carried out using computed tomography (CT), a bone scan and the prostate specific antigen level (prostate cancer). Six patients underwent unilateral laparoscopic dissection, three patients bilateral dissection and one patient required conversion to an open procedure. Operative times ranged from 2 to 3 h, and the number of lymph nodes removed ranged from three to nine (median five). Three patients had their staging altered following LPL (one patient was upstaged and two patients were downstaged), with significant therapeutic implications. Two patients suffered thromboembolic complications while undergoing definitive therapy soon after LPL. Our early results suggest that LPL is valuable in identifying suitable patients for radical therapy as well as excluding patients with lymph node involvement, thereby reducing morbidity.

Rare variants of malignant melanoma.

The personal experience with 5 rare types of malignant melanoma is reviewed to point out some of the practical problems in the diagnosis and management of these tumors. The rare forms discussed are conjunctival, nasal, oral, vulvar, and penile melanomas. All pigmented lesions in the oral cavity, but not the penis or vulva, should be prophylactically excised as lesions in the mouth have a higher malignant potential. Local excision of all 5 forms of primary melanomas, no matter how locally advanced they may be, is the sole treatment. Nevertheless, anatomic constraints often preclude surgery with generous margins and consequently local recurrence, particularly for conjunctival, nasal, and oral primary lesions, is usually the major first failure in treatment. Lymph node dissection is only performed if the regional nodes are palpable at the time of first presentation. Elective lymph node dissections are not performed since the patients are often elderly, the lymphatic drainage is usually ambiguous or multiple, and the disease tends to spread hematogenously rather than lymphatically. Surgery still remains the cornerstone of treatment for these rare forms of melanoma but prognosis is very poor since surgery is often a palliative rather than a curative measure. Improved survival may depend on identifying more effective chemotherapeutic and immunologic agents.

Benign melanosis and malignant melanoma of penis and male urethra

Malignant melanoma of the penis and male urethra are unusually aggressive tumors which only rarely are cured by radical surgery. Melanosis of the penis may be confused with malignant melanoma, and we report a case of melanosis originally diagnosed and treated as melanoma with survival for twenty years. We contrast this with another case of malignant penile melanoma with a fatal outcome.