Malignant melanoma of the female urethra: report of a case with 5-year survival and review of the literature

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.

Long-term survival of a female patient with primary malignant melanoma of the urethra

Primary malignant melanoma of the female urethra comprises 0.2% of all melanomas and has poor prognosis. In the period 1972-1992, 75 cases of primary urethra carcinomas were treated at the Roswell Park Cancer Institute. Among them, only an 80-year-old woman was diagnosed with primary malignant melanoma. Despite conservative treatment, she lived for 7 years. We believe that local surgical excision can be an option for treatment in selected patients as it retains quality of life.

Primary malignant melanoma of the female urethra: a case report

A case of primary malignant melanoma of the female urethra is reported. Physical examination and visceral studies confirmed the primary character of the tumour and histologic examination proved it to be nodular malignant melanoma. Less than 100 cases have been previously reported. The role of immunohistochemical stains to substantiate the diagnosis is stressed. Therapy and prognosis are briefly discussed.

Primary malignant melanoma of the female urethra

BACKGROUND

Malignant melanoma is one of the rarest tumors of the female urethra. The prognosis of urethral melanoma is poor.

METHODS

A 59-year-old woman underwent total urethrectomy, bilateral inguinal lymph node dissection, and vesicostomy for Stage A primary malignant melanoma of the urethra. She received adjuvant therapy consisting of dacarbazine, vincristine, cyclophosphamide, and alpha-interferon. Two years later, repair of the parastomal hernia and interposition of an isoperistaltically ileum intussusception between the bladder and the abdominal wall were done.

RESULTS

Complete continence was achieved, and the patient catheterizes herself every 3-5 hours during the day and once at night without difficulty. She has survived 5 years without any evidence of tumor recurrence.

CONCLUSIONS

There have been only six case reports of women with primary malignant melanoma of the urethra surviving more than 5 years, including this case. Total urethrectomy with bilateral inguinal lymph node dissection should be done as the initial form of the treatment in patients with this disease who have no evidence of distant metastasis. The postoperative adjuvant therapy, consisting of alpha-interferon and chemotherapy, should be administered immediately; therefore, vesicostomy was done because it is a simple procedure. However, this type of urinary diversion requires an external appliance. Clinicians should consider the patient's quality of life, prognosis, and general condition and attempt to solve the problems of patients 2-3 years after the operation.

Malignant melanomas of female urethra

Primary melanoma of the female urethra is extremely rare. Treatment by surgery, radiation, and chemotherapy has been uniformly ineffective. We herein report on 2 patients with primary malignant melanoma of the urethra treated with immunotherapy and chemotherapy. The first patient died four years after the initial diagnosis, and the second died after two years. Chemo-immunotherapy may be considered as an additional, palliative form of treatment in the management of primary melanoma of the female urethra, but cystourethrectomy should be the initial form of treatment.

Primary carcinoma of the female urethra

Experience in the diagnosis and management of 39 female patients with primary carcinoma of the urethra is described. The condition presents to both gynaecological and urological units and has a relatively good prognosis provided that it is diagnosed quickly. There must be, however, a clinical awareness of the condition in those patients presenting with non-specific urological symptoms. Radiotherapy is the treatment of choice using interstitial implants for the superficial tumours and external beam for the deeper tumours. Surgery alone is possible in only a small number of cases, it being reserved mainly for recurrent or resistant disease.

Primary malignant melanoma of the female urethra

We herein report a case of primary malignant melanoma of the female urethra, summarize the histopathology, review the available literature and discuss the treatment. Although a definitive regimen for the treatment of this virulent malignancy has not been established a 10-year-survival has been obtained by surgical extirpation preceded by preoperative radiotherapy.

Primary malignant melanoma of the urinary bladder

A melanin-synthesizing tumor of the urinary bladder was studied by light and electron microscopy. Careful clinical evaluation did not reveal evidence for a primary melanoma elsewhere in the patient. The clinical presentation, course of the disease, and demonstration of melanocytes in the bladder epithelium and malignant melanocytes comprising the tumor by light and electron microscopy indicated that the neoplasm was a primary malignant melanoma arising in the bladder.