Penile melanomas typically present as pigmented macules, papules, or ulcerations with an irregular border on the glans and less often on the prepuce, urethral meatus, and shaft.[3,7,8] A problem in clinical practice is to recognize a pigmented penile lesion as a melanoma. The diagnosis must be confirmed histologically by biopsy of the lesion. The American Joint Committee on Cancer (AJCC) staging protocol for melanoma is the most widely accepted, using the tumor, node, metastasis (or TNM) classification to describe the extent of disease.[6,9,10] The patient presented in this case report was assessed as having AJCC stage 0 (TiS M0 N0) melanoma of the penis.
In Italy, recent National guidelines for cutaneous melanoma diagnosis and treatment suggest that safety surgical margins for the MIS radicalization are 0.5 cm (recommendation strength = III B).
In July 2015, in the United Kingdom the National Institute for Health and Care Excellence (NICE) updated its guideline on assessment and management of melanoma and recommended to consider a clinical margin of at least 0.5 cm when excising stage 0 melanoma and to discuss further management with the multidisciplinary team if excision for stage 0 melanoma does not achieve an adequate histological margin.
Mohs micrographic surgery was not taken in consideration in this context on the basis of the current opinion that it is the best option for patients with larger or clinically indistinct lesions.
The authors thank Dr. Rosanna Quattrin for her contribution to the review of the literature.
. Bechara GR, Schwindt AB, Ornellas AA, et al. Penile primary melanoma: analysis of 6 patients treated at Brazilian National Cancer Institute in the last eight years. Int Braz J Urol 2013;39:823–31.
. Stillwell TJ, Zincke H, Gaffey TA, et al. Malignant melanoma of the penis
. J Urol 1988;140:72–5.
. Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis
. Dermatol Surg 2013;39:527–47.
. Demitsu T, Nagato H, Keiko N, et al. Melanoma in situ
of the penis
. J Am Acad Dermatol 2000;42:386–8.
. Scalvenzi M, Palmisano F, Russo D, et al. Melanoma of the glans penis
successfully treated with topical Imiquimod: dermoscopy usefulness in clinical monitoring and review of the literature. G Ital Dermatol Venereol 2014;[Epub ahead of print].
. Hankins CL, Kotwal S, Majumder S, et al. Multifocal melanoma of the glans penis
. Plast Reconstr Surg 2006;118:33e–8e.
. Lucia MS, Miller GJ. Histopathology of malignant lesions of the penis
. Urol Clin North Am 1992;19:227–46.
. Te CC, Vemulapaalli S, Confer SD, et al. Recurrent malignant melanoma of the penis
. Urology 2008;72:1185.e15–6.
. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009;36:6199–206.
. Edge SE, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th edNew York, USA: Springer; 2009.
. Fenn NJ, Johnson RC, Sharma AK, et al. Malignant melanoma of the penis
. Eur J Surg Oncol 1996;22:548–9.
. Milton GW, Shaw HM. Rare variants of malignant melanoma. World J Surg 1992;16:173–8.
. Creagh TA, Murphy DM. Malignant melanoma of the penis
. Aust N Z J Surg 1993;63:820–1.
. Manivel JC, Fraley EE. Malignant melanoma of the penis
and male urethra: 4 case reports and literature review. J Urol 1988;139:813–6.
. Oldbring J, Mikulowski P. Malignant melanoma of the penis
and male urethra: report of nine cases and review of the literature. Cancer 1997;59:581–7.
. Spencer KR, Mehnert JM. Mucosal melanoma: epidemiology, biology and treatment. Cancer Treat Res 2016;167:295–320.
. Sánchez-Ortiz R, Huang SF, Tamboli P, et al. Melanoma of the penis
, scrotum and male urethra: a 40-year single institution experience. J Urol 2005;173:1958–65.
. Paul E. Malignant lentigo on glans penis
. Der Hautarzt 1976;27:599–602.
. Begun FP, Grossman AC, Diokno AC, et al. Malignant melanoma of the penis
and the male urethra. J Urol 1984;132:123–5.
. Betti R, Menni S, Crosti C. Melanoma of the glans penis
. Eur J Dermatol 2005;15:113–5.
. Lai C, Haddadeen C, Theaker J, et al. Melanoma in situ
affecting the penis
of a naturist. Clin Exp Dermatol 2014;39:58–93.
. Napolitano M, Annessi G, Didona D, et al. Multifocal melanoma in situ
of the penis
treated with topical Imiquimod. J Eur Acad Dermatol Venereol 2014;[Epub ahead of print].
. McKenna JK, Florell SR, Goldman GD, et al. Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment. Dermatol Surg 2006;32:493–504.
. Perez-Gomez B, Pollan M, Gustavsson P, et al. Cutaneous melanoma: hints from occupational risks by anatomic site in Swedish men. Occup Environ Med 2004;61:117–26.
. Agenzia Nazionale per i Servizi Sanitari Regionali. 2012 Linee guida nazionali di riferimento. Diagnosi e terapia del melanoma cutaneo.
. National Institute for Health and Care Excellence. 2015 Nice Guidelines. Melanoma: assessment and management. Available at http://nice.org.uk/guidance/ng14
. Accessed August 31, 2015.
. Erickson C, Miller SJ. Treatment options in melanoma in situ
: topical and radiation therapy, excision and Mohs surgery. Int J Dermatol 2010;49:482–91.
. de Bree E, Sanidas E, Tzardi M, et al. Malignant melanoma of the penis
. Eur J Surg Oncol 1997;23:277–9.