Mrs. I.C., 48 years, consults for a mass on the urethral meatus that she noticed and that has been growing for 2 weeks, associated with dysuria. She hasn’thas no personal or family history of cancer, no alcohol or smoking intoxication. The clinical examination noted a good general condition, a painless ulcer necrotic blackish mass exceeding the urethral meatus of soft consistency and bleeding when touched (Figure 1). On vaginal touch the distal urethra is hard, and the vaginal wall is soft. andAnd the cervix is normal. There was no palpable inguinal adenopathy. Dermatological and other system examinations, looking for another suspicious lesion, were without particularity. The cystoscopy noted a tumor in the distal third of the anterior wall of the urethra - the bladder was normal. A biopsy of the mass was done which revealed a malignant melanoma (figure 2). On immunohistochemistry the proliferation was negative for cytokeratin epithelial markers (AE1/AE3) and was positive for melanic markers (HMB45 and PS100) which confirmed the diagnosis of melanoma. On pelvic MRI there was a 24x17x15 mm oval formation of the right anterolateral wall of the distal urethra (Figure 3), and there was no adenopathy, nor rectal and vaginal involvement. The extension workup includingincluded a thoracoabdominal.

A total cystectomy was performed. The histological results of the resected specimen showed aan urethral malignant melanoma involving the distal 1/3 of the urethra infiltrating the muscle, and the internal 2/3 are healthy, as well as the bladder. It was a malignant melanoma classified as pT2N0M0. The patient had no adjuvant treatment.

The thoraco-abdomino-pelvic CT scan performed at 3, 6 and 12 months after surgery were all normal.

After a one year follow up, the patient is free of any local recurrence.