Malignant melanoma of the anal canal: a case report

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.

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.

Acta medica medianae, 2011

Primary malignant melanoma of the anorectum is rare. It accounts for 0.2-0.3% of all malignant melanomas. Prognosis is very poor since majority of patients dies within first two years. We report a case of a 76 year-old man with anoretal melanoma. Digital rectal examination revealed a mass on the anterior wall. Biopsy report favored two possibilities, first, malignant melanoma and second, poorly differentiated carcinoma. Abdominal ultrasonography and chest X-ray did not show signs of distant metastasis. Computed tomography of abdomen and pelvis revealed presence of a large, irregular hypodense mass with heterogeneous enhancement in anal canal accompanied by enlarged lymph nodes. Abdomino-perineal resection was performed. Histopathological examination of resected specimen confirmed diagnosis of malignant melanoma. Postoperative course was uneventful. However, patient died one year after due to metastasis. Surgery is the mainstay of curative treatment of anorectal melanoma, effective systemic adjuvant therapy has been lacking. Long-term survival is rare, as most patients die of disseminated systemic disease.

Journal of Coloproctology, 2014

Introduction: Malignant melanoma of the anal canal is a rare and aggressive disease, which early diagnosis is diffi cult. Its presentation with no specifi c symptoms leads to a late diagnosis at an advanced stage. The prognosis of anorectal malignant melanoma is poor and frequently related to distant metastasis and absence of response of chemoradiotherapy. Surgery remains the mainstay of therapy; otherwise, the best approach is controversial. Considering no survival benefi ts for APR, wide local excision should be considered as the treatment of choice. Methods: This report collects nine cases of anorectal melanoma treated at our division from 1977 to 2006, as well as a review of the literature. Results: There were eight females and one male, of medium age 69 years (range: 41-85 years). Most frequent presentation was bleeding. Wide Local Excision (WLE) was performed in seven of them. Mean survival was 24 months, and six of them died on account of metastatic disease. Conclusion: Anorectal melanoma remains challenging. Efforts should be taken to early diagnosis, and wide local excision with negative margins is the preferred treatment. Abdominoperineal resection (APR) is a reasonable option for bulky tumors or when the sphincter is invaded.

Annals of International medical and Dental Research

Anal canal malignant melanoma is an uncommon malignancy. It is a highly aggressive tumor that tends to spread early in the course and present with distant metastasis. Due to the rarity of the condition, treatment is yet to be standardized. We report a case of a 47-y ear-old male patient who presented with the history of mass coming out of anus for 6 months, which was misdiagnosed as a case of hemorrhoids. Abdominoperineal resection was done based on tissue biopsy which suggested it to be a primary anal canal malignant melanoma. The diagnosis was later confirmed by histopathological and immunohistochemistry studies, which was strongly positive for HMB 45 AND Melan-A.

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...

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 CURRENT RESEARCH, 2018

A fifty year old hypertensive male presented in the outpatient department with the chief complaints of bleeding per rectum associated with tenesmus while passing stools along with a complaint of a mass protruding from the rectum. A colonoscopic region which was suggestive of a malignant melanoma, while the PET CT revealed a hypermetabolic circumferential wall thickening involving the anal canal and distal rectum with metastatic pelvic nodes, and with an end colostomy. His histopathology with immunohis to chemistry studies were suggestive of high grade malignant melanoma

2021

Malignant melanoma of rectum is extremely rare, and very aggressive disease. It constitutes to about 0.5-4% of all anorectal malignancies and less than 1% of all melanomas. More common in women, typically presents in the fifth or sixth decade of life. Strong association with Caucasian race. Prognosis is very poor with median survival of 24 months and 5-year survival of 10-15%. A timely diagnosis of anal melanoma is made even more difficult by the fact that up to 80% of lesions lack obvious pigmentation and up to 20% of tumors are even histologically amelanotic. Due to rarity of this malignancy there is no consensus on which surgical approach is favorable, also about the adjuvant therapy available. The surgical procedure of choice ranges from an Abdominoperineal resection (APR) to Wide local excision (WLE) with or without adjuvant radiotherapy.