JCU - January 2022 - 64

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Journal of Clinical Urology 15(1)
Figure 1. Low-power view of the bladder wall. The lesion
(upper left) is separated from the urothelium by a thin rim of
lamina propria. Haematoxylin and eosin staining, 40×.
Figure 3. The cells were markedly atypical, with large
nuclei, open chromatin and big eosinophilic nucleoli. Note the
abundant brown pigment. Haematoxylin and eosin staining,
200×.
difficult. Apart from a lack of history of malignant melanomas,
the only morphological criterion favouring a primary
melanoma over a metastasis is the presence of atypical melanocytes
in the margins of the lesion (a finding typical of
primary mucosal melanomas).
Bladder metastases are usually synchronous with disseminated
metastases and confer a poor prognosis.4 The
optimal treatment is debated, and it is currently unknown
whether transurethral resection or cystectomy are able to
significantly impact the prognosis of these patients, in
addition to observation and systemic therapy.
Conclusion
Figure 2. Higher magnification of the image shown in Figure
1. Haematoxylin and eosin staining, 100×.
suspicion. However, sometimes the haematoxylin and
eosin appearance can be very deceptive; for example, an
amelanotic malignant melanoma of the bladder can have
many features in common with a high-grade urothelial carcinoma,
leading to misdiagnosis.2 Even the clinical features
and cystoscopic appearance can be deceiving; innumerable
lesions of the urinary bladder can present with the same
non-specific lower urinary tract symptoms, and some can
even appear cystoscopically as one or more pigmented
spots. Lesions that can mimic melanoma of the bladder
both clinically and cystoscopically include melanosis and
pseudomelanosis (lipofuscinosis and haemosiderosis) of
the bladder. Only careful histological examination can differentiate
between these lesions.11 Differentiation between
primary and metastatic melanomas of the bladder can be
Despite the high and increasing incidence of malignant
melanoma, the urinary bladder is a rare location for this
aggressive disease. Both primary and metastatic melanomas
can localize to the bladder, making the role of the
urologist and the pathologist crucial when the bladder is
the primary site of onset, or when it represents the first
symptomatic metastasis of an otherwise apparently localized
melanoma.
Conflicting interests
The authors declare that there is no conflict of interest.
Funding
The authors received no financial support for the research,
authorship and/or publication of this article.
Ethical approval
Our institution does not require ethical approval for reporting
individual cases or case series.

JCU - January 2022

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