Fatal delayed presentation of primary melanoma of the penis

A 60-year-old man presented with a 3-week history of lethargy, anorexia, breathlessness at rest, nausea and vomiting. He had a 5-year history of an undisclosed, enlarging, pigmented mass on his penis. He refused biopsy of this lesion. Fine-needle aspirate of an enlarged inguinal lymph node histologically confirmed a diagnosis of melanoma and widespread metastases were demonstrated by radiological imaging. The patient succumbed to disease within 8 days of diagnosis. Primary penile melanoma, albeit rare, is an important and sensitive dermatological problem, often leading to delayed presentation.