Case Report: Penile malignant melanoma: insights from a three-case series and literature review on diagnosis and management.

Background: Penile melanoma (PM) is an exceptionally rare and aggressive mucosal melanoma. Currently, it remains poorly understood, and no dedicated clinical guidelines have been established. This study aimed to characterize its clinical features and summarize its treatment options through our original case reports and a contemporary literature review. Case presentation: We present three cases of our medical center, all of whom underwent surgical treatment and were pathologically diagnosed with primary penile melanoma. The first case also underwent postoperative genetic testing and subsequent chemotherapy and achieved a marked reduction of lymph node metastasis. In terms of prognosis, two of them died of progression and one of other diseases. Our literature review subsequently analyzed 27 additional reported cases of PM, which mainly affects middle-aged and older men, with typical manifestations being pigmented patches or nodules on the glans or foreskin. Surgical treatment (local or partial penectomy) was the primary option. Adjuvant therapies, such as chemotherapy and radiotherapy, are commonly used to prevent recurrence, and emerging novel treatments are being evaluated in clinical trials, including immune checkpoint inhibitors and targeted therapies targeting genes such as KIT. Conclusion: Penile melanoma, as a rare but threatening malignancy, requires a personalized management strategy. A reasonable surgical plan should be made to ensure complete resection, with growing evidence supporting the integration of systemic therapies. Further case reports and clinical research are essential to establish standardized protocols.