A Clinical Case of Primary Malignant Melanoma of the Urethra in a Male Patient [Conference Winner Abstract]

Introduction Primary malignant melanoma of the urinary tract is a rare and aggressive malignancy comprising 0,04% of all melanomas. It develops in non-sun-exposed areas predominantly affecting the distal urethra (1,2). Due to the vague early presentation, stigma, and mostly unspecific clinical symptoms, the diagnosis is often made late, most commonly as stage IV which together with high rates of local recurrence greatly contribute to the grim 5-year overall survival rates (3,4). Case Presentation In May of 2024, a Caucasian 65-year-old man with a history of prostate Ca st. II treated with actinotherapy, presented complaining of occasional hematuria. On examination, a black pigmented lesion covering half of the glans penis was observed, accompanied by a polyp-like mass and blood clots in the urethra without signs of active bleeding or regional lymphadenopathy. The diagnosis of melanoma was made via biopsy in January of 2024. On MRI, the neoplastic lesion was found extending to ⅓ of the penis, thus the patient was taken for a glansectomy with a dynamic sentinel lymph node biopsy. Post-operatively a noninvasive malignant melanoma of urethra T3N0M0 st. III was confirmed. The disease did not show signs of radiological progression, thus the patient was put on active surveillance every 6 months. The patient is currently alive and well without radiological or clinical signs of disease progression. Discussion Primary urethral melanoma makes up 4% of all urethral malignancies, despite its rarity, it may vary in clinical presentation or be mistaken for other pathologies. Interestingly, even though the pathology is rarely seen in men, males get diagnosed twice as late in comparison with females, while the 5-year survival between the two is rather similar and generally poor (3,5,6). For a localized malignancy as in our case, surgery remains the primary treatment option; however, the extension of it is in dispute (7,8). That said surgery is ineffective in later stages and the lack of a common staging system with the absence of a systemic therapy protocol poses great challenges in advanced disease management (3,5,8,9). Conclusions Given the rarity and the usual aggressive nature of the primary malignant urethral melanoma, it is crucial to raise awareness for early recognition and timely intervention which may positively influence usually poor outcomes.