Anorectal malignant melanoma: retrospective analysis of management and outcome in a single Portuguese Institution

Abstract

Anorectal melanoma is an uncommon cancer with a poor prognosis. We aim to describe the clinical presentation, treatment and outcome of patients with anorectal melanoma in our center. Retrospective study of patients with anorectal melanoma treated between 2000 and 2011 at a cancer center in Lisbon. Ten patients were identified, eight females and two males, with median age 70.5 years (32-79). Symptoms at presentation were rectal bleeding (8), anal pain (4) and discomfort (3). Tumor location was anal (6), rectal (3) and anorectal transition (2). Seven patients had surgery: abdomino-pelvic resection (5) and local resection (2). Among the two patients who underwent local resection, one was an incidental finding in a hemorrhoidectomy specimen. This patient had further adjuvant chemotherapy (dacarbazine). Three patients had distant metastasis at diagnosis, one had chemotherapy and two had best supportive care. Six of the seven operated patients relapsed in a median time of 5.4 months: distant metastasis (4), local recurrence (1), both (1). The two local relapse patients had surgical widening of resection margins (1) and radiotherapy (2). One-year survival was 30 %; 3-year survival was 20 %. Anorectal melanoma has a poor prognosis due to advanced disease at presentation and aggressive course, with relapse in almost all operated patients. Treatment guidelines have not been established due to the lack of randomized studies. However, recent studies show that sphincter-sparing surgical procedures along with low dose intensity radiotherapy seem to achieve a local control similar to abdomino-pelvic resection. No systemic therapy is considered standard of care for advanced disease, and regimens are extrapolated from cutaneous melanoma experience.

Extensive surgery and lymphadenectomy do not improve survival in primary melanoma of the anorectum: results from analysis of a large database (SEER)

“…Primary AM is a rare and aggressive disease . Radical surgery is the best option for cure and should be the goal of treatment .…”

Synchronous Primary Anorectal Melanoma, Sigmoid Multiple Early Cancers and Descending Adenocarcinoma: A Case Report

“…Anorectal malignant melanoma (AMM) is an extremely rare cancer, which was first reported by Moore DW in 1857. 2,3 AMM is mostly seen in the sixth or seventh decade of life, with a female predominance, and rectal bleeding is the most common symptom. 3,4,5 Changes in bowel movements, rectal pain, and inguinal mass may also be present.…”

“…A norectal melanoma is a rare cancer with a poor prognosis, which accounts for less than 1% of all melanomas and less than 3% of all anorectal cancers. 1,2 The incidence of multiple primary can-cers identified in the colon and rectum is estimated to be about 2% to 11%. 7 Multiple colorectal cancers are extremely rare, few cases can be searched in the literature.…”

Mélanome anorectal primitif

“…En l'absence des consensus clairs par manque d’études randomisées, les moyens thérapeutiques sont représentés essentiellement par la chirurgie réalisant le plus souvent une amputation abdomino-périnéale (AAP) avec curage ganglionnaire inguinal et pelvien, qui semble être un facteur pronostique majeur influençant la survie [ 11 , 12 ]. Ou une exérèse localisée de la tumeur, le recours à l'une des méthodes reste toujours un sujet de controverse.…”

“…Ou une exérèse localisée de la tumeur, le recours à l'une des méthodes reste toujours un sujet de controverse. Cependant, des études récentes montrent que une exérèse tumorale épargnant le sphincter associée à une radiothérapie à faible dose semble atteindre un contrôle local similaire à une résection abdomino-pelvienne [ 11 , 13 , 14 ]. Trois de nos malades ont subis une AAP et deux patients une résection transanale.…”