Rektummelanome – Stellenwert der modernen Therapie

Abstract

Rectal melanoma is a rare disease. There is much controversy concerning cause, incidence and treatment of the disease and the spreading of recurrence. In this article, we discuss actual aspects of diagnostic, therapy and prognosis on the basis of our series of seven patients as well as a literature review. The surgical therapy in the form of local tumour excision with a disease-free margin of up to 1-2 cm is the initial therapeutic modality of choice. Large tumours that obviously could not be removed in sano should be treated with a multimodal concept. Such tumours should be treated by a combination of neoadjuvant radiation and chemotherapy for down-staging with subsequent local excision (LE) or abdomino-perineal rectum extirpation (APR). An inguinal lymphadenectomy should only be performed if the lymph nodes are enlarged on clinical or radiological examination. The prognosis of rectal melanoma is markedly poor and is primarily related with the stage of disease. The 5-year survival rate is estimated at about 24% for patients with stage I tumours. Patients with stage II and III tumours have appreciably shorter survival times of 12 months on the average.

Malignant melanoma of the rectum: a case report

“…Radiation is palliative in extensive tumours while combined chemotherapy is used to palliate metastatic disease. APR appears to have some effect in controlling symptoms caused by local and regional disease but has minimal impact on prognosis [8]. Prompt diagnosis and treatment are crucial to improve outcomes for those affected by this rare cancer.…”

Amelanotisches Rektummelanom – ergänzender Kommentar anhand eines spezifischen Sonderfalls zu Jongen et al.

“…Die chirurgische Therapie ist somit abhängig vom Ausmaß der lokalen Symptome, dem Vorliegen von Fernmetastasen und dem Allgemeinzustand der Patienten. Die prophylaktische bilaterale inguinale Lymphadenektomie hat keinen Einfluss auf die Prognose [22]. Die Detektion des Sentinellymphknotens sollte zum Nachweis okkulter Metastasen angestrebt werden [23].…”