JCU - January 2022 - 63

897497
URO
Journal of Clinical UrologyCaputo et al.
Case Review. Oncology (Bladder)
Urinary bladder metastasis from
malignant melanoma
Alessandro Caputo1,2 , Pasquale Cretella1, Pio Zeppa1,2
and Antonio D'Antonio1,2
Abstract
Bladder metastases from malignant melanoma are very rare, with only about 30 cases reported to date. They are often
associated with synchronous metastases elsewhere in the body and portend poor prognosis. Herein, we present the case
of a 62-year-old man with a history of two completely resected, non-node-metastatic cutaneous malignant melanomas
who presented with gross haematuria as his only symptom. We then proceed to discuss the diagnostic process and
prognostic implications of primary and metastatic malignant melanomas of the urinary bladder.
Level of evidence: 5
Keywords
Oncology (bladder), malignant melanoma, pathology, metastasis, mucosal melanoma
Date received: 17 October 2019; accepted: 4 December 2019
Case presentation
A 62-year-old man presented to our institution with intermittent
painless gross haematuria. His medical history
was significant for two cutaneous malignant melanomas
and two dysplastic naevi resected 1 year prior. One of the
melanomas was thin (Breslow depth: 0.3 mm), while the
other was thicker (Breslow: 3.0 mm) and underwent sentinel
lymph node biopsy, which turned out negative. Both
melanomas were widely resected with negative surgical
margins.
Cystoscopy showed a bluish-brown ulcerated nodule,
which was resected and submitted for pathological examination.
Histological examination of the nodule showed that
the bladder wall was diffusely infiltrated by coalescing nodules
of markedly atypical cells (Figures 1 and 2), with large
eosinophilic nucleoli, scattered mitoses (often atypical) and
areas with abundant brown pigment (Figure 3). The cells
were negative for pan cytokeratin (AE1/AE3), prostate-specific
antigen, chromogranin and synaptophysin, but showed
strong reactivity for S100, HMB45 and melan-A. The overlying
urothelium was mostly ulcerated with some von Brunn
nests remaining (Figures 1 and 2) but showed no signs of
atypia. Molecular analysis showed that BRAF was not
mutated, and further imaging studies revealed multiple
bilateral lung lesions. The patient was started on nivolumab.
Discussion
Despite the high (and increasing) incidence of malignant
melanoma, with as many as 232,000 new cases each year,1
the bladder is a rare site for primary and metastatic malignant
melanomas alike. To date, only about 35 primary and
30 metastatic malignant melanomas of the bladder (including
the present case) have been reported.2-8 Nevertheless,
the real incidence of bladder metastases in autopsy studies
of patients with malignant melanoma is much higher, with
figures ranging between 18 and 37%.9,10
Diagnosis of melanoma of the urinary bladder is based
on immunohistochemical confirmation of a morphological
1Department of Medicine and Surgery, University of Salerno, Italy
2 Department of Pathology, University Hospital 'San Giovanni di Dio e
Ruggi D'Aragona', Salerno, Italy
Corresponding author:
Alessandro Caputo, Department of Medicine and Surgery, University of
Salerno, Via Salvador Allende 1, Salerno, 84081, Italy.
Email: alcap94@gmail.com
Journal of Clinical Urology
2022, Vol. 15(1) 63 -65
© British Association of
Urological Surgeons 2020
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DOI: 10.1177/2051415819897497
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JCU - January 2022

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