{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T09:32:31Z","timestamp":1759743151574,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,3,20]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>We report a case of a 79-year-old woman with urinary incontinence who presented at a urogynaecology appointment. Her medical history included rheumatoid arthritis (RA) treated with methotrexate (MXT) for 22 years. A polypoidal lesion was protruding from the meatus urethrae. The histoimmunocytology confirmed a primary superficial spreading malignant melanoma. The tumour was extensively excised, but 8\u2009months later, due to a lymphatic nodal swelling, a positron emission tomography\/CT was performed showing a process suspicious of malignant melanoma and multiple distant metastasis. The subsequent treatment was palliative and 1\u2009year later, the patient died. The aetiology of malignant melanomas in the urethra is poorly understood. There is consistent evidence that RA is associated with a number of cancers, but it remains controversial whether this risk is increased with MXT. This case emphasises the importance of gynaecological examination even in patients with only weak symptoms from the pelvic region, especially in patients undergoing immunosuppressive treatment.<\/jats:p>","DOI":"10.1136\/bcr-2018-228033","type":"journal-article","created":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T04:26:18Z","timestamp":1554351978000},"page":"e228033","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Primary malignant melanoma of the urethra in a patient with rheumatoid arthritis treated with methotrexate"],"prefix":"10.1136","volume":"12","author":[{"given":"Margrethe Foss","family":"Hansen","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Nordssj\u00e6llands Hospital, Hiller\u00f8d, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Abel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Nordssj\u00e6llands Hospital, Hiller\u00f8d, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Clasen-Linde","sequence":"additional","affiliation":[{"name":"Department of Pathology, Rigshospitalet, Kobenhavn, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,3]]},"reference":[{"key":"2025082801371192000_12.4.e228033.1","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s00404-013-3130-3","article-title":"Primary malignant melanoma of the urethra: a systematic analysis of the current literature","volume":"289","author":"El-Safadi","year":"2014","journal-title":"Arch Gynecol Obstet"},{"key":"2025082801371192000_12.4.e228033.2","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200006000-00003"},{"key":"2025082801371192000_12.4.e228033.3","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1111\/bjd.12421","article-title":"Genital and anorectal mucosal melanoma is associated with cutaneous melanoma in patients and in families","volume":"169","author":"Cazenave","year":"2013","journal-title":"Br J Dermatol"},{"key":"2025082801371192000_12.4.e228033.4","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1053\/j.semdp.2016.04.003","article-title":"Mucosal melanomas: site-specific information, comparisons with cutaneous tumors, and differential diagnosis","volume":"33","author":"Dominiak","year":"2016","journal-title":"Semin Diagn Pathol"},{"key":"2025082801371192000_12.4.e228033.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/000313481608200102","article-title":"Evolving therapeutic strategies in mucosal melanoma have not improved survival over five decades","volume":"82","author":"Kirchoff","year":"2016","journal-title":"Am Surg"},{"key":"2025082801371192000_12.4.e228033.6","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1111\/bjd.15539","article-title":"Methotrexate increases the risk of melanoma: or does it?","volume":"176","author":"Jones","year":"2017","journal-title":"Br J Dermatol"},{"key":"2025082801371192000_12.4.e228033.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.23716"},{"key":"2025082801371192000_12.4.e228033.8","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1111\/bjd.15170","article-title":"Methotrexate treatment and risk for cutaneous malignant melanoma: a retrospective comparative registry-based cohort study","volume":"176","author":"Polesie","year":"2017","journal-title":"Br J Dermatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:37:17Z","timestamp":1756370237000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":8,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,3]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bcr-2018-228033"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228033","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}