Melanoma of the anorectal region

Medical Research Archives

BACKGROUND: Anorectal melanoma (ARM) is an extremely rare, highly aggressive form of a tumor with the worst prognosis. ARM contributes 0.5% of all melanoma cases. Its presentation is similar to that of adenocarcinoma of the rectum, hemorrhoids, or solitary rectal ulcer, the incorrect clinical diagnosis or delayed diagnosis is often made. The definite diagnosis is only made through histopathology in which immunohistochemical stains positive to S-100, Melan A, and HMB-45 which differentiates it from adenocarcinoma of the rectum. Because of the limited number of patients and retrospective design of studies to date, there is no proven efficacy of abdominoperineal resection (APR) over local excision (LE) in terms of survival. Furthermore, this neoplasm is quite resistant to chemoradiotherapy. It has a median survival of 18 months and a 5-year survival rate of only 6%. PRESENTATION OF OUR CASES: Here, we report 5 rare cases of anorectal malignant melanoma presented to our institute betwee...

Nusantara Medical Science Journal

Introduction and importance: Occurring in only 1% of cases of anorectal malignancy, malignant melanoma generally appears in the fifth and sixth decades of life, with complaints of anorectal bleeding or pain. The prognosis is generally poor. Although anorectal melanoma currently lacks a recommended treatment, surgery alone remains the primary modality treatment, the role of adjuvant therapy is generally minimal, and survival rate improves with early diagnosis. Presentation of case : Here, we report two cases of a rare malignant melanoma in the rectum treated with abdominoperineal resection and local excision. The first case is a 60-year-old man with a history of defecating bloody stool and the appearance of a lump on the anal opening. The abdominoperineal resection was performed followed by adjuvant chemoradiotherapy. The second case is a 51-year-old woman with a similar complaint and clinical finding with the first case. The second case was treated with a tumor excision procedure...

2020

Anorectal melanoma is a very rare and aggressive mucosal melanocytic malignancy, accounting for 1% of all anorectal cancers. There have only been a few cases reported. Surgical resection remains the mainstay of treatment. No definitive management strategies exist because of the absence of randomized trials. We here report a case series on four cases of anorectal melanoma. All four cases underwent abdominoperineal resection (APR) and nodal dissection. Two out of four cases received adjuvant temozolomide (TMZ), one case received adjuvant doublet chemotherapy with TMZ and cisplatin, and the fourth case succumbed to nononcological disease before he could be subjected to adjuvant chemotherapy. In the first and third case, nodal dissection was limited to pelvic nodes only. However, in the second case, extensive nodal dissection in the form of bilateral pelvic and inguinal lymph nodal dissection and para-aortic lymph nodal dissection was performed. The fourth case also was subjected to ext...

World Journal of Oncology, 2015

Anal melanoma is an aggressive but rare malignancy. Patients commonly present with very advanced or even metastatic disease. Risk factors for anal melanoma are family history and an activating mutation of C-KIT. Surgical excision remains the mainstay of therapy. The presence of activating mutations of C-KIT has prompted use of C-KIT inhibitors such as imatinib and sunitini. Early diagnosis and treatment remain crucial. Abdominal perineal resection (APR) offers a higher rate of local control whereas wide local excision (WLE) can yield superior long-term survival.

Langenbeck's Archives of Surgery, 2010

Objective Primary anorectal melanoma is a rare entity with a poor prognosis accounting for approximately 0.1-4.6% of anal tumours and 0.5-1.6% of all melanomas. Almost 60% of patients have already disseminated disease at initial diagnosis. Method We report four cases of anorectal melanoma treated at our department from November 2006 to September 2008, as well as a review of the literature. Results There were two females and two males, of median age 69 years (range: 59-81 years). Most frequent complaints were rectal bleeding and/or anorectal pain. Three of our four patients had amelanotic melanomas. We found the positive expression of S-100 protein and HMB-45 in two patients and melanin A cells in one case. Abdominoperineal resection was performed in two patients, colostomy in one patient and a wide local excision also in one case. Three patients died on account of dissemination of melanoma, one patient is still alive. Conclusion Anal melanoma remains a deadly problem. Clear guidelines for the therapy of anorectal melanoma have not been established. This mainly results from the rarity of this tumour. Treatment is based on retrospective studies, which report a limited number of cases.

International Surgery Journal

Anorectal melanoma is a rare cause of anorectal malignancies affecting mainly elderly people without significant gender differences, although there seems to be a white predominance. Diagnosis is often challenging, since symptoms are frequently nonspecific. Radical surgery is the mainstay of treatment, while adjuvant therapies are generally of limited value. Thus, prognosis is still grim, with a 5-year survival rate of less than 20%. We report the case of a 75-year-old white female presenting with mild anal pain and blood in stools. Diagnosed with an ulcerated melanoma of the perianal area, she eventually underwent an abdominoperineal resection and bilateral inguinal lymphadenectomy. To date, she is currently alive and disease-free. Given the lack of adequate international guidelines, we recommend defining a tailored treatment by thorough multidisciplinary discussion, as well as taking into account the patient personal preference.

Annals of surgery, 2015

To determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM). ARMM is a rare and highly malignant neoplasm with unfavorable prognosis. The optimal surgical management, abdominoperineal resection (APR) or local excision (LE), has been long debated, but conclusive evidence has not been obtained. A comprehensive electronic literature search was performed to identify studies evaluating survival between APR and LE for ARMM. The main outcome measures were overall survival, relapse-free survival, and local recurrence. A meta-analysis was performed using the random-effects models to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Thirty-one studies, with a total of 1006 patients [544 (54.1%) APR and 462 (45.9%) LE], were included. Meta-analyses showed that overall survival (OR, 1.14; 95% CI, 0.74-1.76; P = 0.54) and relapse-free survival (OR, 0.95; 95% CI, 0.43-2.09; P = 0.89) did not differ significantly between the APR a...

Cancer Treatment and Research Communications, 2021

Introduction: Anorectal malignant melanoma (ARMM) is an aggressive malignancy with dismal prognosis and a 5year survival rate less than 20% in most of the previous studies. The ideal surgical treatment has still remained controversial. This retrospective study aims at analysing the outcome in patients with ARMM treated with curative surgical resection. Patients and methods: This is a retrospective study of 38 patients of stage I anorectal malignant melanoma treated with curative surgical resection at our tertiary cancer institute. Results: WLE (Wide Local Excision) was carried out in 12 patients and APR (abdominoperineal resection) was done in 26 patients. The median overall survival of the entire group in this study was 20 months. Although the median overall survival of WLE patients was higher than those with APR (37 months versus 16 months, respectively), this was not a statistically significant event (P=0.317). The 1-, 2-, 3-, 5-year survival rates were similar with both APR and WLE with no significant difference in the 5-year survival rate (P=0.816); overall 5year survival rate of just 13%. There were 3 long-term survivors in this study group who survived for more than 10 years. Conclusion: Most patients ultimately succumb to the disease regardless of the management. Both APR and WLE have significant roles in the management depending on the subset of patients selected. Local treatment should be preferred wherever possible. Abdominoperineal resection should be offered in nodal disease or in a recurrent setting. Abbreviations ARMM-Anorectal malignant melanoma OS-Overall survival DFS-Disease free survival APR-Abdominoperineal resection WLE-Wide local excision CT-Computerized tomography MRI-Magnetic resonance imaging

Journal of the American College of Surgeons, 2013

World Journal of Surgical Oncology, 2009

Primary anorectal melanoma is a rare and aggressive disease. Patients commonly complain for changes in bowel habits and rectal bleeding, and proctoscopically they mostly appear as non pigmented or lightly pigmented polypoid lesions. Such a lesion should always raise a high index of suspicion in any gastroenterologist or surgeon to prompt surgery, since early radical excision is the only treatment option. Herein, we report a case of a 57-year-old man with a diffuse anal canal melanoma and give reference to the current diagnostic and treatment options.

Archives of clinical and experimental medicine, 2019

Anorectal malignant melanoma (AMM) is a rare malignant disease with a poor prognosis. This disease is often confused with hemorrhoids. The most common site of malignant melanoma following skin and eye involvement is the anorectal region. This is the most commonly involved site in the gastrointestinal tract. We report the case of a 67-year-old patient with lower gastrointestinal hemorrhage for 4 months and hemorrhoid treatment for 2 months. The imaging revealed no distant metastasis but histopathologically, lymph node metastasis and invasion of surrounding tissues. Laparoscopic abdominoperineal resection (APR) was performed.

Archives of Clinical and Experimental Medicine, 2019

Anorectal malignant melanoma (AMM) is a rare malignant disease with a poor prognosis. This disease is often confused with hemorrhoids. The most common site of malignant melanoma following skin and eye involvement is the anorectal region. This is the most commonly involved site in the gastrointestinal tract. We report the case of a 67-year-old patient with lower gastrointestinal hemorrhage for 4 months and hemorrhoid treatment for 2 months. The imaging revealed no distant metastasis but histopathologically, lymph node metastasis and invasion of surrounding tissues. Laparoscopic abdominoperineal resection (APR) was performed.

Clinical Case Reports

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American Journal of Case Reports, 2021

Objective: Rare disease Background: Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. Case Report: We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month followup, the anal lesion had relapsed, and the patient died 10 months after the procedure. Conclusions: AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.

Folia Medica

Primary melanomas of the anus and rectum are rare neoplasms with aggressive behavior, accounting for 0.1%-4.6% of anal canal tumors. Mucosal melanomas account for approximately 1.2% of all melanomas, of which fewer than 25% are anorectal. Histological evaluation with immunohistochemical stains like HMB-45, S-100, vimentin and Melan A is required for definitive diagnosis. The 5-year survival rate for anorectal melanomas (AM) was reported to be as low as < 20%, in contrast to the value of approximately 80% for cutaneous melanomas. Furthermore, up to 67% of patients are found to have distant metastases at the time of their initial diagnosis with AM. Since the chemotherapy treatment possibilities are limited, patients usually undergo mutation detection tests giving the opportunity of targeted therapy. Herein we report a case of a patient with anorectal melanoma, diagnosed in stage II and the pathomorphological and mutation status finding, together with their correlation to tumor beha...