Adult Urology Prognosis of Primary Mucosal Penile Melanoma: A Series of 19 Dutch Patients and 47 Patients from the Literature Albertus N. van Geel, Michael A. den Bakker, Wim Kirkels, Simon Horenblas, Bin B. R. Kroon, Johannes H. W. de Wilt, Alexander M. M. Eggermont, Wolter J. Mooi, and Madelon N. A. van der Aa OBJECTIVES To analyze the clinical features, prognostic factors, and survival of male patients with primary mucosal melanoma on the glans penis, meatus, fossa navicularis, and distal urethra. METHODS We analyzed the clinical features, prognostic factors, and survival of 66 male patients with primary mucosal melanoma on the glans penis, meatus, fossa navicularis, and distal urethra diagnosed over the past 25 years. Data from our series of 19 patients were combined with those of 47 patients reported in the literature. RESULTS The overall 2 and 5-year survival rates were 63% and 31%, respectively. All patients with nodal and/or distant metastases at presentation died within 2 years. Presence of ulceration, tumor depth of 3.5 mm or more, and tumor diameter greater than 15 mm had a significantly adverse effect on prognosis. CONCLUSIONS The prognosis of primary mucosal penile melanoma is not worse than that for cutaneous melanoma with comparable tumor thickness. Treatment should be similar to that for cutaneous melanoma, with wide radical excision and sentinel node biopsy in clinically lymph node- negative patients. UROLOGY 70: 143–147, 2007. © 2007 Elsevier Inc. P rimary malignant melanoma arising from the mu- cosal membranes is an extremely rare malignancy, comprising less than 4% of all melanomas. Muco- sal melanomas may arise from the mucous membranes of almost all the organ systems, mainly of the head and neck (55%), female genital organs (18%), anorectal region (24%), and urinary tract (3%). 1 Localized in the male genitourinary tract they represent less than 1% of all melanomas. 2,3 The urethra, especially the distal urethra, including the fossa navicularis and urethral meatus (summarized as primary mucosal penile melanoma [PMPM]) is described as the most common location in the urinary tract. Me- lanocytes are of neuroectodermal origin, which is the reason for the low incidence of melanoma in endoder- mally derived epithelia. Published data on mucosal melanomas of the penile region are sparse and consist of case reports or small series. We collected all possible data from all documented cases in The Netherlands over the past 25 years. In addition, we reviewed the literature for detailed reports on mucosal penile melanoma published during this pe- riod and pooled the data of 47 patients with data from our series of 19 patients. MATERIAL AND METHODS We performed a retrospective study of all histologically con- firmed cases of mucosal malignant melanoma of the penis diagnosed in The Netherlands since 1979. Data were retrieved from the PALGA (Pathological Anatomical District Automa- tized Archives) database. Nineteen patients with PMPM were found. Clinical Data To obtain clinical information, questionnaires were sent out to the specialist in charge. Items included in the questionnaire were date of birth, relevant previous history (oncologic and family), date of first presentation and symptoms, date of diag- nosis, initial treatment, date and treatment of local recurrence, date and treatment of (lymph node and/or distant) metastases, and date and status of last follow-up. Pathologic Review One pathologist (M.d.B.) reviewed all slides. To describe the extent of the tumors all tumors were evaluated for single prog- nostic factors of primary melanoma: growth phase thickness From the Department of Surgical Oncology, Erasmus Medical Center/Daniel den Hoed Cancer Center, Rotterdam; Departments of Pathology and Urology, Erasmus Medical Center, Rotterdam; Departments of Urology and Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam; and Department of Pathology, Free University Medical Center, Amsterdam, The Netherlands Reprint requests: Albertus N. van Geel, M.D., Ph.D., Department of Surgical Oncology, Erasmus Medical Center/Daniel den Hoed Cancer Center, Groene Hilledijk 301, Rotterdam 3075 EA, The Netherlands. E-mail: a.n.vangeel@erasmusmc.nl Submitted: October 19, 2006; accepted (with revisions): March 13, 2007 © 2007 Elsevier Inc. 0090-4295/07/$32.00 143 All Rights Reserved doi:10.1016/j.urology.2007.03.039