Two case reports of malignant melanoma rectum

PubMed, 1997

The aim of the study was to describe the diagnostic procedure, indications for operation and operative result in a patient with primary malignant melanoma of the rectum. In the patient, hospitalized at the Department of Surgery, School of Medicine in Zagreb, a malignant melanoma of the rectum was diagnosed by rectoscopy and histology. Tumor staging was determined by endorectal ultrasonography. Operation was indicated for malignant disease with partial obstruction of the rectum. Since the tumor was locally inoperable, with liver metastases a palliative operative procedure (sigmoidal colostoma) was performed. The operative finding confirmed the tumor stage obtained by ultrasonography. The patient died 5 months after the operation due to widespread dissemination of the malignant disease. Thereby, the accuracy of preoperative tumor staging by ultrasonography was confirmed. We believe that, in view of its accuracy, endorectal ultrasonography can be used for tumor staging in patients with primary melanoma of the rectum. Therefore, expensive diagnostic imaging methods like CT and MRI are no longer necessary.

International Surgery Journal

Melanomas are primarily tumours of the skin, but rarely occur at other sites like retina and anal canal. Anorectal melanoma is an uncommon condition associated with a very poor prognosis. The patient usually presents with per rectal bleed or mass. These are often misdiagnosed on presentation. Diagnosis is confirmed by biopsy. Treatment is abdominoperineal resection or wide local excision if tumour free margins can be obtained. We present a case of a 60 years old female who presented to the outpatient department with per rectal mass and bleed since 4 to 5 months and was diagnosed with melanoma anal canal on biopsy. CT scan abdomen and pelvis was done. Patient underwent abdominoperineal resection as wide local excision with sphincter saving was not possible due to the location and extent of tumour as seen on CT scan. Patient had an uneventful recovery after the procedure.

Cureus, 2020

Malignant melanoma of the rectum comprises 0.5%-4% of all anorectal cancers. Malignant melanoma of the rectum is exceptionally a rare disease. It commonly affects the fifth or sixth decade, with nonspecific symptoms such as rectal bleeding or anal pain. After skin and retina, anorectum is the third common site for malignant melanoma. Proper diagnosis is difficult in the majority of cases due to lack of pigmentation and amelanotic histological appearance. Prognosis is very poor with a median survival of 24 months and fiveyear survival of 10%-15%. Anorectal malignant melanomas disseminate along the submucosal planes, therefore complete resection at the time of diagnosis is usually not possible.

Nigerian Journal of Clinical Practice, 2018

Aim: In this study, we aimed to evaluate the clinical characteristics and outcomes of the patients with anal melanoma (AM), who underwent surgical treatment. Materials and Methods: This study was conducted in Kartal Training and Research Hospital between January 2010 and December 2017. All patients, who underwent surgical resection with a diagnosis of AM, were enrolled. Results: A total of 10 patients were examined, 8 of them were females, and their average age was 69.2 years (range, 47–85 years). Abdominoperineal resection (APR) was performed in five (50%) patients, and local excision (LE) was performed in other five (50%) patients. Three patients (30%) had stage I disease, two (20%) had stage II disease, and five (50%) had stage III disease. All five patients in APR group had stage III disease. In the comparison of the survival period after surgery, the mean survival period of the APR group was 6.2 months (range, 1–16 months) while that of the LE group was 19.6 months (range, 7–43...

International Archives of BioMedical and Clinical Research, 2016

A 50-year-old male presented with major complaints of bleeding per-rectum and generalized weakness for past one and a half month. Digital rectal examination (DRE) and colonoscopy revealed a thrombosed internal haemorrhoid, which was surgically excised. Histopathological examination (HPE) was pointing towards anal malignant melanoma, which was further confirmed by positive immunohistochemistry (IHC) for HMB-45. As the patient had no secondaries or lymph node enlargement, he was referred for loco-regional radiotherapy. Primary ano-rectal melanoma is a rare but locally aggressive neoplasm capable of early metastasis. Owing to its non-specific clinical presentation it may be mistaken for benign conditions like haemorrhoids and may prove fatal. Surgical treatment may range from wide local excision (WLE) to abdomino-perineal resection (APR) with controversial role of chemo-radiation in advanced cases. Prognosis is usually bleak with a 5-year survival rate of less than 20%. Owing to the rarity of ano-rectal melanoma and importance of its early detection and management, this case is being reported here.

Primary anal malignant melanoma is an uncommon and aggressive disease. In many cases, the disease is undetected or mistaken for a benign polyp or haemorrhoids until it reaches an advanced stage. Extracutaneous melanomas require special consideration due to their late diagnosis and consequently poor prognosis. Extracutaneous melanomas are considered to be biologically more aggressive than their cutaneous counterparts. Surgical excision remains the cornerstone of therapy. This case is reported because of the rarity of the disease in anal canal found in an 80 year old female who was managed with wide local excision of the growth.

Annals of Pathology and Laboratory Medicine, 2020

Ano-rectal melanoma is extremely rare and has dismal prognosis when compared to cutaneous melanomas. It presents as ano-rectal mass and patients usually complain of passing blood in stools. Being, a highly aggressive neoplasm, widespread metastasis is common, which can be seen even at the time of diagnosis. Here, we present a case report of ano-rectal melanoma in a 40-year old male, who presented with complaints of anal growth since one month. Initially, a clinical diagnosis of rectal carcinoma was suspected. However, biopsy of the growth showed histomorphological features of melanoma, which were confirmed on immunohistochemistry.

The American surgeon, 2012

Anal malignant melanoma (AMM) is a rare tumor with poor prognosis. We performed a systematic review of reports on wide local excision (WLE) and abdominoperineal resection (APR) for treatment of AMM in an attempt to define a precise set of reporting measures for outcomes of treatment of AMM. A systematic review of the literature was performed. Demographic data, surgical treatment, pathology, and survival rates were recorded. We compared WLE versus APR in terms of the overall survival time, the disease-free survival, and overall survival at 60 months. Twenty-one reports met the inclusion criteria. Notably, of these, 10 did not specify thickness of the primary melanoma. Interestingly, groin lymph node status was described in 19 of 21 reports, whereas location was specified in only 12 papers and thickness (depth in mm) in only 11. The median survival times of patients undergoing WLE (n = 324) and those undergoing APR (n = 369) are comparable (20 and 21 months, respectively). The mean me...

International Journal of Gastroenterology Research and Practice, 2015

Objective: Primary Malignant Melanoma (PMM) arising from the digestive, respiratory or genitourinary tract is extremely rare. Rectal PMM accounts for less than 1% of all melanomas; it is often advanced at initial presentation with a poor prognosis with a 5-year survival below 20%. Treatment of this particular disease is still debated with weak evidence that aggressive surgery may lead to a better outcome. The objective of the present paper is to descibe a case of PMM and review the published literature on the treatment of such extremely rare condition. Methods: A 78 years old man presenting mild anal bleeding underwent a colonoscopy which showed a centimetric mass in the posterior wall of the rectum, less than 1 cm above the pectinea line. Biopsy revealed amelanotic malignant melanoma infiltrating the submucosa. Preoperative assessment revealed no distant metastases and no nodal involvement. Abdominoperineal resection (APR) with total mesorectal excision and iliac nodes sampling was performed. Results: the patient is alive and disease-free after 48 months from diagnosis. According to a literature review, APR with or without intra abdominal pelvic lymph node dissection represents a more radical approach in patients seeking curative options. However, some series suggest that wide local excision (WLE) may have similar survival outcomes but seems to be burdened with a higher rate of local recurrences. Conclusions: Our experience confirms that treatment recommendations are not standardized and tend to be individualized. An aggressive surgical approach may be justified in patient with a long life expectancy accepting a demolitive surgery and a definitive colonostomy.

Journal of contemporary brachytherapy, 2009

This article is one case report of 49 year-old woman diagnosed with malignant melanoma of the anal canal. The tumor was detected at early stage and initially treated with local excision, followed by adjuvant interstitial brachytherapy. Since the patient complained of painful local ulceration and atypical cells were found at biopsy, abdominoperineal resection of the rectum was performed and a sterile specimen was obtained, proving the efficacy of adjuvant brachytherapy for local control. Patient is now considered disease free for 30 months after primary treatment.

2016

Anorectal melanoma is an uncommon and aggressive disease. We present one case of rectal malignant melanoma with history of chronic constipation in one Iranian man. In April 2015, a 73-year-old farmer man referred to Clinic of Surgery with complaints of abdominal pain and bloody stool since two months ago with history of chronic constipation. He did transanal rectal mass resection. The IHC report in May 2015, showed that Melan-A and HMB-45 were positive and synaptophysin and LCA were negative. Eight days later, he did abdomino perineal resection with pelvic lymph node dissection. A rectosigmoid sample with dimension 22.5*3.5 cm and thickness of 2cm with distance of 1.5cm from rectum’s margin was sent to pathobiology laboratory. Five days after surgery, the patient was ill with abdominal pain, tachypnea, respiratory distress and black necrotic malodorous site of colostomy. He died in June 2015 (five days after second surgery) due to cardiopulmonary arrest unresponsive to cardiopulmona...

Medical Practice and Reviews, 2014

Cutaneous melanomas are rare in the Indian population and mucosal and anorectal lesions are seen but very occasionally. They often masquerade as hemorrhoids leading to delay in diagnosis. This was a retrospective study done in Sri Ramachandra University, where hospital records were perused to record all cases of anal melanomas. Abdomino-perineal resection and wide local excision offer equal survival rates. Novel targeted therapy represents the cutting edge of therapy today.

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...

National Journal of Community Medicine, 2012

Malignant melanoma is very rare in the rectum. Prompt diagnosis and treatment is necessary as chances of metastasis is very high. A 56 year old male patient came to surgical OPD for complaint of something coming out per rectum. Polyp was identified on per rectal examination the biopsy revealed malignant melanoma. Abdominoperineal resection was done. We reported this case as it is uncommon and also there is controversy in surgical treatment of choice.

Ejso, 2009

This study describes the experience of the National Cancer Institute of Milano in the treatment of anorectal melanoma over the last 32 years.The influence of different surgical approaches on local care and final outcome was investigated on 40 completely evaluable patients, followed for a median follow-up time of 75 months. The analysis was carried out by calculating and comparing overall survival, disease-free survival and cumulative incidence curves of disease recurrence.Thirty-one patients underwent radical surgery: nine abdominoperineal resections, four total rectal resections and coloendoanal anastomosis, and 18 local excisions. The remaining nine patients received palliative treatments. Median overall survival time for patients receiving non-radical treatments was poor: only 6 months. However, even when a radical surgery was undergone, the prognosis of patients with anal melanoma remains dismal. Local relapse incidence was 45.8% for the limited surgery group, but non-existent for the extended-surgery group (p = 0.007). However, the median disease-free survival time was 7 and 9 months for patients receiving limited or major surgery (p = 0.97). Overall survival was 17 months, irrespective of the adopted surgery.Prognosis of anal melanoma remains poor. Final outcome is not influenced by modality of surgery. A limited but radical excision can be considered whenever possible while a major demolitive surgery should be applied only for therapy of advanced or bulky lesions.