Multidisciplinary management of urethral melanoma

Primary urethral melanoma is a rare and aggressive neoplasm with limited therapeutic evidence and typically delayed diagnosis. We report the case of a 54-year-old woman diagnosed with urethral melanoma, treated by local excision, subsequent margin re-excision, and laparoscopic right inguinal lymphadenectomy for a palpable node, followed by adjuvant pembrolizumab, achieving favorable evolution and no recurrence at six months. Clinical, molecular, and therapeutic aspects of this entity are reviewed, emphasizing the role of initial surgical excision, limited response to immunotherapy, and lack of standardized protocols. Optimal management requires an individualized multidisciplinary approach and further research to improve outcomes.