Chavdar Slavov

Elenko Popov

Georgi Venkov

Kalina Velikova

Nikolay Tsankov

Svetla Christova

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131Acta Dermatovenerol Croat                   2009;17(2):131-133                           CASE REPORTMalignant Melanoma of Glans Penis and Prepuce Treated with Organ-Preserving Surgical ProcedureChavdar Slavov1, Georgi Venkov1, Kalina Velikova2, Svetla Christova2,  Elenko Popov1, Nikolay Tsankov31University Department of Urology; 2Department of Pathology, School of Medicine, Medical University; 3Department of Dermatology, Medical University, Sofia, BulgariaCorresponding author:Professor Nikolay Tsankov, MD, PhDDepartment of DermatologyMedical UniversitySofia, Bulgariatsankn@abv.bgReceived: October 23, 2008Accepted: February 24, 2009summary The authors present a case of malignant melanoma of glans penis and prepuce. An organ-preserving operative procedure using buccal mucosa was performed with subsequent inguino-femoral modified lymphadenectomy. There was no disease progression during the follow-up period of twelve months.Key words: malignant melanoma, glans penis, prepuce, organ-pre-serving surgical procedure, buccal mucosa IntroduCtIon Genitourinary localization of malignant mela-noma is extremely rare and is associated with poor prognosis. Its frequency is below 1% of neo-plasms of genitourinary tract (1). Literature review yields isolated reports on malignant melanoma of glans penis (2,3); malignant melanoma of prepuce (4); and malignant melanoma of corpus of the pe-nis (5-8). Reports of multifocal localization of geni-tourinary malignant melanoma are also extremely rare (9,10). The low number of reported cases does not allow for development of a standardized therapeutic protocol, which results in treating ma-lignant melanoma very often similarly as other ma-lignant tumors of the penis.  We present a case of malignant melanoma of glans penis and prepuce, which was treated with an organ-preserving operative procedure and bi-lateral inguinal and femoral lymphadenectomy. Case report Our patient was a 65-year-old Caucasian male with a major complaint of a dark-bluish spot on the back of glans penis. The patient had noticed the lesion two years before, but in the past two months it grew substantially and colored black. On physical examination, a tumor growth measuring 20x10 mm was observed, originating from glans penis near corona glandis, of inhomogeneous 132 ACTA DERMATOVENEROLOGICA CROATICAbrown-black color and comparatively smooth but firm surface (Fig. 1). Another mobile rounded le-sion of 5x6 mm in dimension and bluish color was found on the inner preputial surface.   On palpation of lymph nodes in the left inguinal area, a slightly enlarged lymph node measuring 10x12 mm and suspect of metastasis was found. Computer axial tomography (CAT) and ultrasonog- Following thorough discussion with the patient, upon his explicit request, an organ-preserving operative procedure was performed, i.e. partial glansectomy with circumcision into healthy tissue, confirmed with histologic slides (Fig. 2). The de-fect in glans penis was covered with a free buccal mucosa graft (Fig. 3), followed by bilateral inguinal Figure 1. Non-homogenous, brown-black tumor measuring 20x10 mm, located on glans penis. Figure 2. Partial glansectomy with circumscision in healthy tissue.raphy (US) of pelvic and abdominal area did not reveal any pathologic signs. Colloid scintigraphy of inguinal lymph nodes revealed a single zone of increased activity in the left inguino-femoral area.Figure 3.  Buccal mucosa graft for covering the defect on glans penis.Figure 4. Excised lymph nodes with a macroscop-ic metastasis.Figure 5. Histopathologic examination with hema-toxylin-eosin staining (x100): malignant melanoma exulcerating the epithelium with marked vertical expansion and scarce deposition of pigment in su-perficial layers.and femoral lymphadenectomy (Catalona) as the second procedure. In one of the excised lymph nodes, a macroscopic metastasis of characteristic black color was found (Fig. 4).  Figure 6. The patient one year after the surgery.Slavov et al.      Acta Dermatovenerol CroatMalignant melanoma of glans penis    2009;17(2):131-133133ACTA DERMATOVENEROLOGICA CROATICA Pathology report indicated malignant melano-ma ulcerating the epithelium, with marked vertical expansion. There were scarce pigment deposits in superficial layers (Fig. 5). On immunohistochemis-try, S100 reaction was positive in 50% and HMB reaction in 45% of tumor cells. One year after the operation, the patient felt healthy, with organ preserved function and no signs of new metastasis (Fig. 6).dIsCussIon Malignant melanoma is one of the most malig-nant neoplasms in human pathology. It is a pig-ment tumor, which results from malignant trans-formation of nevi or precancerous melanosis of Dubreuilh. Nowadays it is generally accepted that most melanomas develop de novo, while only 25%-40% of melanoma arise in conjunction with a melanocytic nevus (11). Malignant melanoma is an extremely rare tumor in the region of male geni-tals, where its most frequent localization is glans penis (8). The diagnosis is based on the charac-teristic brown-black color of the lesion and results of histopathologic examination. The prognosis de-pends on clinical stage (Bracken and Diokno clas-sifications), and on the depth and level of tumor invasion (Breslow index, Clark’s degree of dermal invasion) (8).  The case described is interesting because of the rare localization, involving both glans penis and prepuce. The treatment of malignant melanoma is pre-dominantly surgical, the scope being determined by tumor stage, patient age and his sexual activity. Partial glansectomy followed by inguino-femoral bilateral lymphadenectomy provides an opportu-nity the disease control and better quality of life (3). Covering the defect in glans penis with a buc-cal mucosa graft yields superior cosmetic results and allows for effective closure of the wound. ConCLusIon Surgical treatment of penile melanoma using Mohs micrographic surgery as well as sentinel lymph node biopsy should also be considered (12). references1.   Millan-Sagaste ML, Asensio-Lahoz L, Monge-Mirrales J, Perez Martin A, Fernandez Lerones MJ, Guezmes Domingo AJ, et al. Melanoma of the penis. Actas Urol Esp 2003;27:152-4. 2.   Bett R, Menni S, Crosti C. Melanoma of the glans penis. Eur J Dermatol 2005;15:113-5.3.   Testori A, Mazzarol G, Viale G, De Cobelli O, Lotti M, Rocco F, et al. Medical decision ma-king for melanoma of the glans penis. J Exp Clin Cancer Res 1999;18:219-21.4.   Wad S, Ito S, Yamamoto S, Yoshimoto M, Inoue K, Yoshimura R, et al. Malignant melanoma in penile foreskin. Hinyokina Kiyo 2004;50:657-9.5.   Orlandini V, Avril MF. Melanoma of the penis. Ann Dermatol Venereol 2004;131:609-10.6.   Hori J, Kato Y, Iwata T, Taniguchi N, Hashimoto H, et al. A case of penile malignant melanoma. Hinyokina Kiyo 2003;49:493-6.7.   Andorian S, Meterissian SH, Watters AK, Loutfi A. A case of penile melanoma, illustra-ting the low sensitivity of frozen sections in the assessment of sentinel lymph nodes. Can J Urol 2003;10:1947-9.8.   Chabannes E, Wallerand H, Bernardini S, De-biere F, Allouc H, Bittard H.  Malignant penile melanoma. Prog Urol 2000;10:101-5.9.   Sanchez-Ortiz R, Hyang SF, Tamboli P, Prie-to VG, Hester G, Pettaway CA. Melanoma of the penis, scrotum and male urethra: a 40-year single institution experience. J Urol 2005;173:1958-65.10. Orlandini V, Kolb F, Spatz A, Court B, Ortoli JC, Sabourin C, et al. Melanoma of the penis: 6 cases. Ann Derm Venereol 2004;131:541-4.11. Burgdorf W, Plewig G, Wolff H, Landthaler M, eds. Braun-Falco’s Dermatology. Springer, Heidelberg, 2009. pp. 1416-7.12. Kim S, Brock GB, Temple CL. Minimizing mor-bidity in the treatment of penile melanoma: Mohs micrographic surgery and sentinel lymph node biopsy. Can J Urol 2007;14:3467-70. Slavov et al.      Acta Dermatovenerol CroatMalignant melanoma of glans penis    2009;17(2):131-133

Malignant Melanoma of Glans Penis and Prepuce Treated with Organ-Preserving Surgical Procedure

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Malignant Melanoma of Glans Penis and Prepuce Treated with Organ-Preserving Surgical Procedure

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