Anorectal melanoma: surgical management guidelines according to tumour thickness

Abstract

Management of patients with anorectal melanoma is still controversial. To reach a rationale therapeutic approach, we reviewed our experience obtained over the past decade. In all, 19 consecutive patients with the diagnosis of anorectal melanoma were included in this retrospective survey. Details of the patients' presentation, symptoms, tumour size and histology and tumour state were recorded, and the primary therapeutic procedures were evaluated in detail. The size of the tumours ranged between 0.5 and 7 cm in diameter. The median tumour thickness was 10 mm (range 0.6 -40 mm). At diagnosis, six of 19 patients already presented with either regional or distant metastases. The remaining 13 patients were treated with curative intend, either by abdomino-perineal resection (APR) or wide local excision (WLE). The form of operative therapy, however, had no impact on overall survival. Nevertheless, the incidence of local recurrences was lower after APR even for patients with less favourable tumours. In conclusion, WLE alone is not sufficient for local tumour control of thick anorectal melanoma.

Optimizing local control in anorectal melanoma

“…[4,8,9,11,15] The recommended margins for excision is 1 cm, [1,4] though one author has suggested guidelines for management of anal melanoma based on tumor thickness. [15] Our resection includes the underlying internal sphincter. As long as the anorectal bundle and the external sphincters are intact, patients will remain continent, as has been the case in all our patients who underwent WLE.…”

Prolapsed Anorectal Melanoma

“…However, the choice of operation continues to be controversial because the prognosis is so poor. Additionally, long-term survival rates, which range from 0 % to 29 %, do not seem to differ when wide local excision or APR is performed [3][4][5]. However, some studies have shown fewer loco regional recurrences with a more radical operation, thereby supporting the use of APR for earlier-stage tumours.…”

A Fatal Case of Primary Anal Melanoma in a Patient with Diagnosed Haemorrhoids

“…The two widely used surgical interventions are abdominoperineal resection (APR), which reduces the risk of recurrence to a minimum however necessitates colostomy, or wide local excision, which results in greater functional preservation however a higher risk of disease progression [7].…”