We report the case of a 70-year-old man with a history of gastrectomy for gastric adenocarcinoma 12 years ago and prostate carcinoma Gleason VII, (2 cylinders of 6 affected by the tumor), treated surgically with PSAro radical prostatectomy ten years ago.
He came to the Emergency Department of our hospital for presenting a painless exophytic lesion at the glans level of about five weeks of evolution.
He did not remember having had any previous injury or trauma in the area, and reported from the appearance of the lesion some episode of bleeding with the friction.
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On examination of the patient we observed on the dorsum of the glans an exophytic rounded lesion of dark red color of approximately two centimeters in diameter, with a tendency to bleeding, elastic consistency and not painful.
No fixed lymphadenectomy was performed and the rest of the physical examination was normal
Biopsy of the lesion was performed during the intervention, which was a tumor of macroscopic appearance non-existent, located in the mucosa of the glans, with areas of thrombosed appearance and easily friable.
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Intraoperative pathological analysis was reported as a lesion composed of undifferentiated cells with nuclear hyperchromatism, pleomorphism and a large number of mitoses and pigment epithelium, which would be compatible with the diagnosis of melanoma.
The resection was completed with a subtotal penectomy with four centimeters safety margin from the edge of the lesion and a bilateral superficial inguinal lymphadenectomy with lymph nodes not affected by the tumor.
An abdominal CT scan showed no metastatic disease.
Pathological examination of the penectomy specimen revealed a maximum invasion depth of 1.5 mm. Immunohistochemical analysis with S-100 and HMB 45 confirmed the diagnosis of melanoma (1).
