Jacobs Journal of Clinical Case Reports

Metastatic Melanoma of the Urinary Bladder in the Era of Targeted Therapy

*Luke Wang
Department Of Urology, Australia

*Corresponding Author:
Luke Wang
Department Of Urology, Australia
Email:drlukewang@gmail.com

Published on: 2016-03-21

Abstract

Metastasis of malignant melanoma to the urinary bladder is a rare clinical entity. Here we present the case of a 78 year-old man with metastatic melanoma in his bladder found on surveillance cystoscopy for previous bladder urothelial carcinoma, in the context of concurrent BRAF and MEK inhibitor therapy for melanoma metastasis to other sites. The bladder lesions were histologically confirmed to be melanoma, but despite lower urinary tract symptoms he was managed expectantly and succumbed to his disease some months later. This is only the second case in the English literature reporting bladder metastases from malignant melanoma with concurrent treatment of targeted therapy. There has been recent promise of longer survival amongst patients with metastatic melanoma afforded by these new therapies, and accordingly we may see a rise in incidence of stable metastases to rarer sites of spread and a need for improved local control of metastatic sites. Although we did not treat our patient’s bladder metastasis more aggressively due to his guarded prognosis, this case highlights the potential for metastasis to rarer sites in the context of increased survival from new therapies and the lack of relevant targeted intravesical treatments for bladder metastases.

Keywords

Melanoma; Metastases; Bladder; Urology; Cystoscopy

Introduction

Since 1953, only approximately 24 cases over the duration of 52 years have been reported making metastatic melanoma to the urinary bladder a rare clinical entity[1]. These tumours typically present with painless macroscopic haematuria but are otherwise more frequently discovered at autopsy [1,2]. This suggests that in the majority of cases, treatment would only be expectant due to the very limited survival of this patient cohort. The discovery of PD-1 inhibitors and the use of targeted therapies such BRAF and MEK inhibitors have shown great promise in enhancing survival. Here we present the case of a 78 year-old man with deposits of metastatic melanoma within his bladder found on surveillance cystoscopy for previous bladder urothelial carcinoma 25 years following excision of the primary lesion. This occurred in the context of treatment with both BRAF and MEK inhibitors for known metastatic melanoma to other systemic sites. To the best of our knowledge, there is only one other report of metastatic melanoma to the urinary bladder in the context of concurrent treatment with targeted therapy in the English literature [3].