Primary Melanoma of the Penis in 3 Patients With Lichen Sclerosus

Report of Cases | Case 1. A man in his 50s presented with a firm nodule growing in the left coronal sulcus over 4 months (Figure). Three years earlier, he had been diagnosed with GLSc and unsuccessfully treated with topical steroid preparations of various potencies. Ultimately, he underwent a curative circumcision that same year with histological confirmation of GLSc. Clinically, SCC was suspected, and an excisional biopsy was performed that showed a primary nodular melanoma with a Breslow thickness of 1.2 mm and Clark level 5. Ulceration was seen. Perineural, vascular, and lymphatic invasion were absent. Excision was incomplete, but the patient declined further surgery. There was some clinical and histologic uncertainty whether the penile lesion was a secondary deposit rather than a primary melanoma. Meticulous clinical examination and extensive initial staging revealed no alternative primary nor metastatic disease. Two months later he developed subcutaneous melanoma deposits on his chest as well as pulmonary and liver metastases. He declined chemotherapy and was treated palliatively until he died.