Melanoma presenting as a urethral caruncle

A urethral caruncle is a common benign vulvar lesion in postmenopausal women. We describe a case of malignant melanoma that originally presented as a caruncle.

A 73-year-old female presented to the urogynecology office for prolapse. Initially, she was diagnosed with a urethral caruncle that was noted to be enlarging on a subsequent exam. A biopsy was taken, which returned with poorly differentiated malignant melanoma.

The patient was referred to gynecologic oncology and underwent wide local excision of the urethral mass and urethral reconstruction with bilateral sentinel inguinal lymph node biopsy and mapping. The final pathology was consistent with stage pT4b N0 (sn) pMx malignant melanoma. She is currently undergoing adjuvant immunotherapy.

Malignant melanoma of the urogenital tract is more common in postmenopausal women and can present as a urethral caruncle. When urethral caruncles are not responsive to initial medical therapy, providers should maintain a broad differential, including vulvar malignancies and biopsy when indicated.