Primary melanoma of the female urethra is a very rare malignant tumor with high mortality. Due to its rarity, there are no guidelines and recommendations on the diagnosis and treatment of such patients, so we aimed to review the reported cases and case series, their treatment, and outcome. We searched through PubMed for all articles reporting on female urethral melanoma. We found 73 articles (case reports and case series) reporting on 112 patients. There are no clinical trials on the topic due to the rarity of the condition. Median patient age at presentation is 68 years. Due to the late presentation, the prognosis of the disease is poor, and median survival is 16 months, with 5-year survival in around 10 % (12 reported patients). Regarding treatment, most authors use either less radical approach (partial or total urethrectomy) or radical approach (anterior pelvic exenteration). We found no evidence that either of the treatment modalities results with higher survival. In local excision, there are indications that margins less than 2-2.5 cm result in high percentage of local recurrence suggesting that resection width should be at least 2.5 cm. For localized urethral melanoma, local resection with margins of 2.5 cm can be recommended and there is no foundation to support radical surgery in such patients. Chemotherapy and immunotherapy can also recommend. For locally advanced disease, the prognosis is poor, and radical surgery will not improve survival significantly.