Unusual penile malignancies in circumcised Jewish men

Primary malignant melanoma of the urethra: a clinicopathologic analysis of 15 cases

The clinical and pathologic features of 15 primary urethral melanomas occurring in patients (nine women and six men) age 44 to 96 years (mean age, 73 yrs) are described. In the men the tumor involved the distal urethra. In eight women it involved the distal urethra, usually the meatus; both the distal and proximal urethra were involved in one woman. The tumors were typically polypoid and ranged from 0.8 to 6 cm (mean, 2.6 cm) in maximum dimension. A vertical growth phase was present in all tumors, with a prominent nodular component in seven of them. A radial growth phase was seen in nine tumors. The depth of invasion ranged from 2 to 17 mm. The tumors had diffuse, nested, storiform, or mixed growth patterns. The neoplastic cells typically had abundant eosinophilic cytoplasm, large nuclei with prominent nucleoli, and brisk mitotic activity. Melanin pigment was seen in 12 tumors but was conspicuous in only six. At the time of diagnosis, 13 tumors were confined to the urethra and two patients had lymph node metastasis. Nine patients died of disease 13 to 56 months after initial diagnosis and treatment, and one patient had a local recurrence at 4 years and subsequently died of sepsis 1 year later. Three patients were alive and well at 11 months, 23 months, and 7 years. One patient died at the time of the initial operation, and one died of a ruptured aortic aneurysm at 3 years without evidence of melanoma at autopsy. Primary malignant melanomas of the urethra, one fifth of which are amelanotic, must be included in the differential diagnosis of a number of primary neoplasms that involve the urethra, including transitional cell carcinoma, sarcomatoid carcinoma, and sarcomas. Conventional prognostic factors, such as depth of invasion or tumor stage, do not seem to play as important a role in predicting survival as the mucosal location and the nodular growth present frequently in these tumors.

The management of meatal obstruction due to Kaposi's sarcoma of the glans penis

Kaposi's sarcoma involving the glans penis was first described in 1902, with a subsequent report of meatal disease in 1943. With the recognition of the acquired immunodeficiency syndrome, genital lesions are becoming more frequently reported, with 51 cases cited in the literature. To date only 4 additional cases of meatal or fossa navicularis involvement have appeared in the literature, 3 of which described difficulty with micturition. We report a case of Kaposi's sarcoma involving the urethral meatus resulting in documented outflow obstruction, relieved with simple urethral serial dilation performed on an outpatient basis followed by intermittent obturation. We believe that this therapy represents a low risk, cost-effective treatment modality aimed at resolution of symptoms and alleviation of a potential source of infection in the patient with the acquired immunodeficiency syndrome.

Primary Classic Kaposi's Sarcoma Limited to the Glans Penis (Not Associated with Acquired Immunodeficiency Syndrome)

We report two cases of primary Kaposi's sarcoma limited to the glans penis. In circumcised men the basic lesion appears as a reddish-violet nodule. The patients denied homosexuality, drug abuse or blood transfusion. Excision of the lesion with wide margins and radiotherapy was adequate therapy. Serological investigations for HIV were all negative. At two years and one year after operation the patients are well with normal serology.

Radiation therapy for classic Kaposi's sarcoma presenting only on the glans penis

Kaposi's sarcoma is an endothelial neoplasm with a variety of clinical presentations that rarely involve only the glans penis. Although it is recognized as a radiosensitive lesion, most of the reported cases of penile Kaposi's sarcoma have been treated surgically. We describe 2 otherwise healthy men with this unusual presentation of Kaposi's sarcoma who were treated with radiation therapy. These cases and a review of the literature demonstrate the role of radiation therapy in the conservative management of classic Kaposi's sarcoma involving the penis.

Primary malignant melanoma of male urethra

A case of primary malignant melanoma of the male urethra is reported. Treatment included partial urethrectomy, bilateral inguinal and iliac lymphadenectomy, and post-surgical systemic chemotherapy. After thirty-six months, the patient is alive with cutaneous, pelvic lymph node, and gastric metastases.

Primary malignant melanoma of the male urethra

Primary malignant melanoma of the male urethra is a rare disease, with only 24 cases previously reported in the literature, including 1 black patient. We describe 2 additional patients with primary malignant melanoma of the urethra, one of whom was a black man. The literature is reviewed briefly and treatment recommendations are discussed.

Spontaneous healing of Kaposi's angiosarcoma of the penis

We report a case of Kaposi's angiosarcoma of the penis. Few cases have been reported of the initial and exclusive involvement of Kaposi's angiosarcoma of the glans penis and prepuce. Our case is unique because of the number of lesions and the spontaneous remission.

Malignant melanoma of the penis and male urethra. Report of nine cases and review of the literature

Nine cases of primary malignant melanoma of the penis and male urethra are presented. The age range of the patients was 57-77 years. Five patients had intermittent bleeding, one had pain, and three were asymptomatic. Six patients had the melanoma on the glans or prepuce and three in the urethra; two presented with inguinal lymph node metastases. Penile amputation was performed in six patients, local excision in three, groin dissection in four, and one was given radiotherapy. Postoperative metastases were seen in eight patients, four of whom were treated with surgery, alone or in combination with radiotherapy, and one with chemotherapy. Two patients are still living, at 2 and 14 years after diagnosis, respectively. Seven patients have died of their tumors, five of them within 2 years. This confirms the consensus of available reports that, irrespective of what type of therapy is used, prognosis is poor in patients with malignant melanoma of the penis and urethra.

Carcinoma of skin of penis

Like the Jews, the Ibos or Igbos of Nigeria ritually circumcise males on the eighth day of birth. A retrospective review of approximately 15,000 surgical specimens collected from this ethnic group over a period of 13 years revealed 32 cases of carcinoma of the prostate but only 4 cases of penile carcinoma. One tumour arose on the glans penis. This localisation pattern suggests that, in circumcised males, smegma-induced squamous carcinoma of the glans can be abolished but not the ordinary squamous carcinoma that can develop by chance on the rest of the penis as well as on the glans. International urology would benefit from careful documentation of squamous carcinoma affecting various parts of the neonatally circumcised penile skin.

Melanoma of the male urethra: surgical approach and pathological analysis

Primary urethral melanoma in male subjects is rare and optimum therapy has not been established. We described a male patient with a primary urethral melanoma that arose in a precursor nevus and was treated by excision, bilateral groin dissections and postoperative radiation therapy. Urinary and sexual functions have been maintained. We review the previously reported cases of urethral melanoma in male subjects. The biologic relationship of melanoma to precursor lesions in mucosal sites is discussed.

Kaposi's sarcoma of scrotum

A rare case is presented of Kaposi's sarcoma localized to the scrotum with history, and physical and laboratory findings. Excision of the scrotum with bilateral orchiectomy was performed, with uneventful recovery. Literature is reviewed of Kaposi's sarcoma originating in the male external genitalia.

Benign melanosis and malignant melanoma of penis and male urethra

Malignant melanoma of the penis and male uretha 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.