Melanoma; Penis; Lymph
Nodes; Penile Neoplasms
Int Braz J Urol. 2013; 39: 823-31
Submitted for publication:
April 19, 2013
Accepted after revision:
August 15, 2013
Purpose: To describe our experience in treating penile melanoma in 06 patients follo-
wed at our institution.
Materials and Methods: Between 2004 and 2012 six consecutive patients with penile
melanoma were treated at our Institution. Stage of the disease was classified accor-
ding 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 speci-
mens 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 in-
guinal lymph nodes at diagnosis and underwent bilateral inguinal lymphadenectomy
and received systemic chemotherapy (dacarbazine, 30 cycles).
Results: 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%.
Conclusion: 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.
The first case of penile melanoma was des-
cribed 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 el-
derly 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 pri-
mary carcinomas of the penis (3). Most frequently,
the lesion is located on the glans (55%), followed by
foreskin (28%), penile shaft (9%) and urethral mea-
tus (8%) (4).The involvement of urinary tract mucosa
Penile primary melanoma: analysis of 6 patients treated at
Brazilian national cancer institute in the last eight years
Gustavo Ruschi Bechara, Aline Barros de Santos Schwindt, Antonio Augusto Ornellas, Diogo Eugênio
Abreu da Silva, Felipe Monnerat Lott, Franz Santos de Campos
Departments of Urology (GRB,AAO,DEAS,FML,FSC) and Pathology (ABSS), Brazilian National Cancer
Institute, Rio de Janeiro, RJ, Brazil
Vol. 39 (6): 823-831, November - December, 2013
IBJU | penile priMary MelanoMa
is more common in females and the explanation is
the higher concentration of melanocytes in the mu-
cocutaneous border of the vulva (5).
A problem in clinical practice is recognizing
a pigmented penile lesion as a melanoma. The use
of the dermatoscope may be useful in differential
diagnosis with other pigmented skin lesions such
as: melanosis, nevus, lentigo, and atypical pigmen-
ted macula of penis, however the diagnosis must
be made by biopsy of the lesion. Indeed, one of the
major mimickers of mucosal melanoma, and thus of
penile melanomas, is melanosis. Clinically, despite
its benign behavior, melanosis can, at times, share
features with malignant melanoma as asymmetry,
irregular borders, multifocality, variegated pigmen-
tary patterns and large size. Due to late diagnosis
and lack of well established treatment protocols, the
prognosis is generally poor. However, although it is
an aggressive disease, it is possible to maximize cure
with treatment in its early stages.
Given the rarity of the disease, we report our
experience with the treatment of six patients with
penile melanoma between 2004 and 2012.
MATERIALS AND METHODS
We reviewed, after approval by the INCA
Ethical Committee with the number 38/05, the
charts of six patients who were consecutively ad-
mitted to Brazilian National Cancer Institute to
treat penile melanoma between 2004 and 2012.
After detailed anamnesis, physical examination
was performed with careful palpation of the pri-
mary lesion and the inguinal region, seeking pal-
pable lymph nodes. Following, we performed a
biopsy of the lesion. A case of melanoma in the
penile glans is shown in Figure-1.
All slides were reviewed by a single patho-
logist (ABSS). All tumors were evaluated for major
prognostic factors. To determine the real extent
and dimension of the injury, the analysis inclu-
ded the depth (Breslow) and size of the lesion, the
presence or absence of necrosis, ulceration and
satellite nodules. We also analyzed the number of
mitoses per field, presence or absence of associa-
ted in situ melanoma (Tis) and characteristics of
resection (R0, complete or R1 when the margins
Regression was observed in associated area of lesion
“in situ”. Figures of mitoses, ulceration, and vascu-
lar or perineural invasion were not observed. In the
second case, the slides showed ulcerated tissue frag-
ments, and necrotic tumor emboli that populated
vessels and corpus cavernosum, constituting some-
times, metastatic nodules. Areas of regression were
observed. Mitoses were not found and the thickness
of the lesion and stage could not be assessed. Viral
cytopathic changes consistent with HPV were ob-
served even in non-neoplastic skin.
In tumors occurring in the mucosa, one ori-
ginated in the glans, and the other into the urethral
orifice. The glans had a nodular type melanoma
measuring 2 mm thick. It had no mitoses, vascu-
lar invasion or regression. But there was perineural
invasion and foci of ulceration graded as pT1b. In
the second case the injury that began in the mucosa
of the urinary meatus, in an average of 7 mm, was
Figure 1 - Pigmented, exophytic and irregular lesion with
poorly defined borders, located in and around the glans
meatus, measuring approximately 3.0 cm.
IBJU | penile priMary MelanoMa
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Antonio Augusto Ornellas, MD
Department of Urology
Instituto Nacional de Câncer
Praça da Cruz Vermelha, 23
Rio de Janeiro, RJ, 20230-130, Brazil