Primary penile melanoma.

Primary penile melanomas are exceedingly rare (less than 1% of primary penile cancers), 221 cases being reported to date in PubMed indexed medical literature. More than half of the cases occur on the gland, usually in older people than on cutaneous counterpart and have unfavourable prognosis mainly due to the belated diagnosis. We report the case of a 77 years old male diagnosed with a pigmented ulcerated nodular melanoma of the gland with maximal thickness of 4.5 mm, mitotic index 8 mitoses/mm2 and vascular emboli. No lymph node enlargements or distant metastases were identified at presentation. Six months after the diagnosis the patient was well, free of disease. Clinically, penile melanomas may be mistaken for several lesions such as squamous carcinoma, penile nevi, pyogenic granuloma, Kaposi sarcoma. Histopathologic diagnosis is usually straight forward except for highly pleomorphic tumors; discrimination between primary penile tumor and penile metastatic melanoma is the most delicate problem of differential diagnosis. The treatment is not standardized; surgical wide excision or partial/total penectomy completed with sentinel lymph node biopsy are the most frequent methods of treatment; multi-agent chemotherapy and/or high-dose interferon alpha 2b therapy are recommended for patients with locally un-controllable disease and/or metastases.