Urogenital mucosal melanoma can be found in the bladder, urethra or the penis. It is a very rare type of melanoma, accounting for only 0.1% of all cases. It may show as a dark pigmented area with irregular borders.
Mucosal melanomas of the vulva and vagina are covered in a separate guide.
Urogenital mucosal melanoma can affect different parts of the urinary and genital tract.
Penile mucosal melanoma develops on the mucosal surfaces of the penis, most commonly the glans or urethral meatus (the opening of the urethra at the tip of the penis). It can also affect the inner foreskin. It starts in the pigment-producing cells (melanocytes) like other melanomas. The melanoma may be darker than the surrounding areas, appearing blue-black or brown in colour, with an irregular border. In some cases the melanoma does not have more pigment or is colourless (amenalotic).
Melanoma can also occur on the skin of the penile shaft or scrotum, although these are usually known as cutaneous (skin) melanomas rather than mucosal melanomas. For treatment of cutaneous melanoma see our melanoma stages and treatment guide.
Urethral mucosal melanoma develops in the lining of the urethra, the tube that carries urine out of the body. It can affect any part of the urethra and occurs in both men and women.
Bladder mucosal melanoma develops in the lining of the bladder, the organ that stores urine before it is passed from the body.
The causes of urogenital mucosal melanoma remain largely unknown and may be a combination of age, genetics and environmental factors. Penile melanoma can be found in men of any age, but it is most commonly found in individuals over 60.
The symptoms associated with urogenital mucosal melanoma depend on the area affected. Bladder and urethral mucosal melanomas may have few or no symptoms and can be discovered during tests for another problem.
Symptoms may include:
• Pain, bleeding or unusual discharge from the penis
• Difficulty passing water
• Swelling, a lump or an ulcer
• Darkened or pigmented areas (This may be blue-black, or brown in colour).
• Irritation or itching
• Pain during sex
• Swelling in the groin
• Blood in the urine
• Pain, burning, or discomfort when passing urine
• Changes in urinary frequency
• Bleeding or discharge from the urethra
• Pain or burning when passing urine
• Changes in the urinary stream or frequency
The symptoms are often similar to other symptoms of types of cancer. These symptoms can also have a non-cancer related cause. It is therefore important to arrange an early appointment with your GP, so they can take the most appropriate action quickly.
If your GP cannot find another cause for these symptoms, you should be referred quickly (normally within about two weeks) to a specialist clinic for tests. This may involve an appointment with a urologist or urogenital cancer consultant, melanoma specialists and nurse specialists.
It is important you see your GP if you have symptoms or any unexplained symptoms that are worrying you. If your GP has any concerns or if they are not sure what the problem is, they will refer you to a hospital specialist who will examine you and will arrange for you to have a biopsy. This is a small sample of the tissue that will be removed under local anaesthetic to look for cancer cells. It is then analysed by a pathologist (a specialised doctor who diagnoses diseases from tissue and cells in the body) to decide whether it is a melanoma or not.
It typically takes a few weeks to receive the results of your biopsy and this can be a very anxious time. You may have other tests to help diagnose mucosal melanoma and these tests can also be used to check whether your melanoma has spread to other parts of the body.
After a diagnosis of urogenital mucosal melanoma, your medical team will work out the ‘stage’. The stage is a way of describing the key features of your melanoma and is helpful in guiding the best treatment and follow-up for you. Your stage provides an indication of how advanced your melanoma is. Generally, the higher the stage, the more advanced it is.
For most melanomas of the skin (cutaneous melanoma), doctors use an internationally recognised staging system called the TNM system. This system is developed by organisations such as the American Joint Committee on Cancer (AJCC). It describes the tumour (T), whether cancer has spread to nearby lymph nodes (N), and whether it has spread to other parts of the body (M, metastasis).
However, there is currently no internationally agreed staging system specifically for urogenital mucosal melanoma. For this reason, doctors should still record the tumour using similar TNM terms, as this helps ensure important clinical information is captured consistently.
Since there is no agreed staging system, urogenital mucosal melanoma is often staged using the Ballantyne staging system:
Stage 1= the melanoma is ‘localised’ which means it is only in the urogenital (bladder, urethra or penile) area and it has not spread anywhere else
Stage 2= the melanoma has spread to nearby lymph nodes (AJCC equivalent staging for cutaneous melanoma would be Stage 3)
Stage 3 = the melanoma has spread (metastasised) to other parts of the body (AJCC equivalent staging for cutaneous melanoma would be stage 4).
Some mucosal melanomas in this area are found to be similar to skin cancer and are staged using the TNM system.
The main treatment for urogenital mucosal melanoma is surgery. This should be done by a surgeon who is very experienced in complex urogenital cancer surgery, in a specialised centre, with support from an experienced cancer team.
There are a number of different approaches to surgery depending on its location and how advanced it is. In planning the operation, the medical team will consider the stage of your mucosal melanoma, your general health and how the surgery may affect your quality of life.
Since this is an intimate part of your body, you may want further support or counselling to help with the emotional aspects and consequences of surgery. Your medical team should be able to provide you with details.
In some situations, you may be offered immunotherapy or a targeted therapy after the surgery. This is known as adjuvant treatment and is given to reduce the risk of the mucosal melanoma coming back. In some cases, immunotherapy may be given before surgery (known as neoadjuvant treatment). Your specialist cancer team will discuss whether these treatments may be suitable for you.
If the urogenital mucosal melanoma has spread to other parts of your body you may be offered other treatments such as immunotherapy, targeted therapy or the option of taking part in a clinical trial.
For more information on immunotherapy treatment, click here.
For more information on targeted therapy, click here.
For more information on clinical trials, please visit the Melanoma TrialFinder.
If you have any questions about your diagnosis or treatment, our specialised Melanoma Helpline nurses are here to support you on
During September 2020 Jonathan was diagnosed with stage 2 ano-uro-genital mucosal melanoma, and in November 2020, he underwent his first surgery to remove this. Unfortunately, the cancer had not been fully removed with clear margins and the operation had to be repeated. Jonathan has a rare mucosal melanoma which has further spread, and additional surgeries and treatments have continued, and he is now looking into alternative treatment options.
Carvajal RD, Spencer SA, Lydiatt W. Mucosal Melanoma: A Clinically and Biologically Unique Disease Entity. J Natl Compr Canc Netw (2012) 10(3):345–56. doi: 10.6004/jnccn.2012.0034
Omer Onur Cakir Edoardo Pozzi et al., Clinical features, molecular characteristics and surgical management of primary penile mucosal melanoma (2021) Melanoma Res 32: 27–34 DOI: 10.1097/CMR.0000000000000788
Rambhia PH, Scott JF, Vyas R, et al. Genitourinary Melanoma. Chapter 5. (2018) Available from: https://www.ncbi.nlm.nih.gov/books/NBK506990/ doi: 10.15586/codon.noncutaneousmelanoma.2018.ch5
