Primary malignant melanoma of the female urethra: a case report and literature review

Primary urethral malignant melanoma is an extremely rare malignancy of mucosal origin. Its clinical manifestations are non-specific, often leading to misdiagnosis or delayed diagnosis. Due to its highly aggressive nature and propensity for early metastasis, patient prognosis is generally poor.

This case report describes an 81-year-old Chinese female patient who presented to the Department of Urology at Gansu Provincial Hospital with the chief complaint of "a black mass at the external urethral meatus accompanied by urinary incontinence for two months. Physical examination revealed a dark, protruding mass at the external urethral orifice. Imaging studies showed no evidence of distant metastasis. The patient underwent a "Radical Resection of Urethral Mass." Due to significant urethral shortening following tumor resection, a concurrent "retropubic urethropexy" was performed to preserve postoperative urinary continence. Postoperative pathology and immunohistochemistry confirmed the diagnosis of malignant melanoma. The patient declined adjuvant targeted therapy postoperatively. Short-term follow-up indicated no tumor recurrence, with satisfactory recovery of urinary function.

For primary urethral malignant melanoma, radical surgical resection remains the primary treatment modality. In this case, the combination of radical surgery with a concurrent urethropexy procedure achieved complete tumor removal while effectively preventing postoperative urinary incontinence resulting from local anatomical disruption. This approach highlights the importance of individualized, multifunction-preserving treatment strategies for such rare cases. Enhancing clinical awareness of this disease is crucial for facilitating early diagnosis and improving patient prognosis.