Synchronous bilateral testicular metastases of malignant melanoma: a case report and literature review

Metástases testiculares bilaterais sincrónicas de melanoma maligno: relato de caso e revisión da literatura

Background: Metastatic melanoma to the testis is rare and is often identified incidentally at autopsy. Its presence at diagnosis typically indicates widespread disease. This report presents a case of testicular metastasis from malignant melanoma and a literature review to evaluate its clinical presentation, diagnostic approach and prognostic implications. Case: The case of a 56-year-old male diagnosed with testicular metastasis from melanoma was assessed, and a review of literature was conducted to identify similar cases using PubMed, Cochrane, Embase and Google Scholar databases until 16 July 2024, with the search terms: (Testis OR Testicular OR Testicle) AND (Metastases OR Metastatic OR Metastasis). A total of 15 articles were identified for the analysis. Metastatic melanoma to the testis is typically diagnosed at a median age of 60 years (range: 28 to 83 years). While some patients remain asymptomatic, others present with a palpable mass, testicular enlargement or pain. The size of testicular lesions varies widely, ranging from 1 to 9 cm. Ultrasonography typically reveals hypoechoic nodules, while computed tomography (CT) often demonstrates heterogeneous nodules with vascularization. The distribution of testicular metastases is reported as follows: right testicle in 43% of cases, left testicle in 47% and bilateral involvement in 10%. Inguinal orchiectomy was performed both for diagnostic and therapeutic purposes. The primary melanoma may originate from various anatomical sites. Reported Breslow thickness values range from 1.5 to 11 mm, and the Clark levels vary between II–IV. Metastases frequently affect the lungs, lymph nodes, retroperitoneal adenopathies and brain. The prognosis remains poor, with a median survival of 11 months. Conclusions: Testicular metastasis from melanoma represents an aggressive manifestation of the disease, typically indicating advanced-stage malignancy. Early diagnosis, inguinal orchiectomy and systemic therapies remain essential. Further research is needed to explore individualized treatment strategies and their impact on survival and quality of life.

Resumen

Antecedentes: El melanoma metastásico testicular es una entidad sumamente rara, frecuentemente identificada de forma incidental durante la autopsia. Su detección al momento del diagnóstico suele reflejar una enfermedad diseminada. En este informe se presenta un caso de metástasis testicular por melanoma maligno, acompañado de una revisión de la literatura para analizar su presentación clínica, abordaje diagnóstico y repercusiones pronósticas. Caso: Se analizó el caso de un paciente de 56 años con metástasis testicular de melanoma, acompañado de una revisión de la literatura en PubMed, Cochrane, Embase y Google Scholar hasta el 16 de julio de 2024, utilizando los términos: (Testis OR Testicular OR Testicle) AND (Metastases OR Metastatic OR Metastasis). Se identificaron 15 artículos para el análisis. El melanoma testicular metastásico se diagnostica, en promedio, a los 60 años (rango: 28–83). Algunos pacientes son asintomáticos; otros presentan masa palpable, aumento testicular o dolor. El tamaño de las lesiones varía entre 1 y 9 cm. La ecografía suele mostrar nódulos hipoecoicos, y la tomografía computarizada revela nódulos heterogéneos con vascularización. Las metástasis afectan el testículo derecho en el 43 % de los casos, el izquierdo en el 47 % y son bilaterales en el 10 %. Se realizó orquiectomía inguinal con fines diagnósticos y terapéuticos. El melanoma primario puede originarse en múltiples localizaciones. El grosor de Breslow varía entre 1,5 y 11 mm, y los niveles de Clark entre II y IV. Las metástasis suelen extenderse a pulmones, ganglios linfáticos, retroperitoneo y cerebro. El pronóstico es desfavorable, con una mediana de supervivencia de 11 meses tras el diagnóstico. Conclusiones: La metástasis testicular de melanoma representa una manifestación agresiva con mal pronóstico. Las tasas de supervivencia siguen siendo limitadas. La orquiectomía inguinal y las terapias sistémicas son fundamentales. Se necesita mayor evidencia sobre enfoques personalizados y su impacto en la calidad de vida.

Testicular; Metastasis; Melanoma; Orchiectomy; Metastatic melanoma

Palabras Clave

Testicular; Metástasis; Melanoma; Orquiectomía; Melanoma metastásico

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