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Case Report
Primary melanoma of the female urethra
1 Department of Urology, Atrium Health, Charlotte, North Carolina
2 Carolinas Pathology Group, Charlotte, North Carolina
Address correspondence to:
Sagar Rohitkumar Patel
Department of Urology, Atrium Health, 1021 Morehead Medical Drive, Suite 6100, Charlotte 28204,
North Carolina
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Article ID: 100028Z11SP2019
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Patel SR, Nordsiek MF, Johnson MM, Riggs SB. Primary melanoma of the female urethra. J Case Rep Images Pathol 2019;5:100028Z11SP2019.ABSTRACT
Introduction: Of all melanoma cases, approximately 0.2 occur in the female urethra. Although cutaneous melanoma is considerably more prevalent, there are a few reports of primary melanoma of the urethra. We report a rare case of primary melanoma arising from the female urethra as well as the management of this individual with a novel immunologic based therapy.
Case Report: A 78-year-old Caucasian female presented to urology clinic for further evaluation related to her previous urethral tumor resection. Histopathologic evaluation of the resected tumor showed melanoma involving the urethral mucosa and lamina propria, with extensive ulceration and focal invasion into lymphovascular structures. Tumor margins were positive on microscopy. Metastatic survey with positive emission tomography scan of body was negative. Repeat cystoscopy showed persistent mass, approximately 1-2 cm distal to the urethral sphincter. Surgical resection would have required full urethrectomy and cystectomy to achieve a negative margin. The patient was presented with two alternative therapeutic options: radical surgical extirpation or systemic immunotherapy in combination with local radiation. Ultimately, the patient pursued a treatment paradigm of systemic therapy with anti-PD-1 antibody- based immunotherapy (pembrolizumab) and radiation.
Conclusion: In the recent years, immunotherapy has become a promising therapeutic option for urethral melanoma. Primary female urethral melanoma is a rare occurrence without clear guidelines for optimal surgical and medical management.
Keywords: Anti-PD-1 Antibody, Immunotherapy, Melanoma, Urethral neoplasm
SUPPORTING INFORMATION
Author Contributions
Micheal F. Nordsiek - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sagar Rohitkumar Patel - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Matthew M. Johnson - Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Stephen Boyd Riggs - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Sagar Rohitkumar Patel et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
