Melanoma - Anogenital in
See also in: Overview,Hair and Scalp,Oral Mucosal LesionAlerts and Notices
Synopsis
Melanomas can be found anywhere on the body, including the glans penis, foreskin, shaft, anus (see anorectal melanoma), urethra, and the scrotum. Primary melanomas of the glans penis and male urethra are rare, representing < 0.1% of all melanomas. Anogenital melanoma is responsible for approximately 0.05% of all colorectal malignancies and 1% of all anal canal cancers. Scrotal melanomas are equally as rare. Melanomas of the genitalia most often arise de novo in elderly individuals.
The best prognostic indicator is the Breslow thickness, a measure of the depth of invasion of the melanoma. Lesions less than 0.75 mm in thickness generally have a good prognosis, while lesions greater than 3.5 mm have a very poor prognosis. A higher percentage of male genitourinary melanomas than cutaneous melanomas are at an advanced stage at the time of diagnosis, either as a result of late presentation (urethral melanoma) or delay in seeking medical care, leading to a poorer outcome. Urethral melanomas, especially, have a worse prognosis than cutaneous melanoma.
There are no established guidelines for staging of mucosal melanoma and scrotal melanoma. For glans and penile melanoma, both the American Joint Committee on Cancer (AJCC) staging criteria and a 3-stage system have been used:
Stage 1: Lesion is confined to the penis.
Stage 2: Metastatic to the regional lymph nodes.
Stage 3: Disseminated disease.
Codes
ICD10CM:C43.9 – Malignant melanoma of skin, unspecified
SNOMEDCT:
372244006 – Malignant melanoma
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Penile lentiginosis
- Erythroplasia of Queyrat
- Bowenoid papulosis
- Bowen disease (pagetoid or pigmented)
- Squamous cell carcinoma
- Zoon balanitis
- Extramammary Paget disease
- Seborrheic keratosis – Presence of pseudo horn cysts is typical.
- Pigmented basal cell carcinoma – Pearly quality.
- Atypical nevus
- Kaposi sarcoma
- Angiokeratoma
- Hemangioma – Cherry, thrombosed.
- Metastatic carcinoma
- Epidermal inclusion cyst on the scrotum
- Leiomyosarcoma on the scrotum
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:06/13/2022
Last Updated:06/14/2022
Last Updated:06/14/2022
Melanoma - Anogenital in
See also in: Overview,Hair and Scalp,Oral Mucosal Lesion