Case presentation:
A 70-years-old man without any specific medical history presented to our institution with skin lesions of the penis gland that have appeared for three months. His physical examination revealed hyperchromic, greyish, nodular, and ulcerated lesions. The largest of which was 1 cm in diameter on the penile gland and around the urethral meatus, Associated with a fixe right inguinal lymphadenopathy of 3cm in diameter [figures A].
A surgical biopsy on the skin lesion with histopathological and immunohistochemical studies confirms the diagnosis of melanoma. The Breslow index was estimated to be at least 4 mm with a Clarck and Mihlim level IV and the mitotic index at tree mitoses per 10 high power fields.
A Thoraco-abdominopelvic CT scan was performed and demonstrated the presence of multiple secondary hepatic lesions, the largest of which are visible in segments VI and VII measuring 20 mm and 16mm, respectively, with a right inguinal and iliac lymphadenopathy [figures B].
The patient received treatment with immunotherapy (pembrolizumab 200 mg / 21 days). After two years of follow-up of immunotherapy, the patient is still stable with good clinical and biological tolerance [figures C].