An 83-year-old woman with a painful distal urethral mass presented to the urology department. Results of a cystoscopy revealed a 4-cm dark pigmented lesion in the bladder (
image A). The patient was evaluated for a primary skin lesion or other primary malignancies, which was found to be negative. She underwent distal urethrectomy and transurethral resection of the bladder tumor, and HMB-45 and S-100 staining revealed melanoma of the urinary tract (
image B). After this diagnosis, the patient underwent bladder preservation therapy with external beam radiation and close surveillance. This treatment delayed disease progression for 20 months, at which point the patient developed metastatic disease and elected to receive hospice care. Primary melanoma originating from the urinary tract is an extremely rare occurrence and requires extensive evaluation to exclude another primary site.
1-4