Prognosis Of Anorectal Melanoma Research Articles

S2623 Metastatic Anorectal Melanoma as a Rare Cause of Hematochezia: A Case Report

Introduction: Anorectal melanoma is a rare and aggressive subtype of gastrointestinal cancer, accounting for 0.5% of all colorectal cancers. Misdiagnosis of anorectal melanoma is common, as cases oftentimes present with nonspecific symptoms including hematochezia. As such, timely and accurate diagnosis of anorectal melanoma is difficult due to its rarity and nonspecific presentation. Consequently, prognosis is poor due to frequent metastasis by the time of diagnosis. Case Description/Methods: A 65-year-old male with a history of basal cell carcinoma of the cheek and tobacco use presented with 10 days of hematochezia associated with dyschezia and change in caliber of stool. The patient was noted to have a 10-pound weight loss since a positive fecal immunochemical test 5 months prior. Notably, while he had not had a colonoscopy, his records revealed a prior sigmoidoscopy for similar complaints 4 years prior. Sigmoidoscopy was negative for polyps or tumors but diagnostic of segmental colitis associated with diverticulosis (SCAD); symptoms resolved after a course of oral mesalamine and antibiotics. Family history was positive for a brother with esophageal cancer. Labs were unremarkable for anemia or liver panel abnormalities. Computed tomography imaging of the abdomen showed sigmoid wall thickening, pelvic lymphadenopathy, and multiple liver lesions. Colonoscopy revealed a 0.8 × 0.5 × 0.1 cm anal mass with biopsies consistent with malignant melanoma; stains were positive for HMB45 and negative for p40 and p63. An ultrasound-guided liver biopsy showed metastatic melanoma positive for HMB45 (Figure 1). Discussion: Hematochezia can arise from anatomical, vascular, inflammatory, and neoplastic etiologies. Although neoplastic causes are the least common, anorectal melanoma represents an especially rare and dismal diagnosis from this category. Risk factors for anorectal melanoma are unknown, although HIV has been previously suggested. HIV screening in our patient was negative. An association between anorectal melanoma and SCAD is unclear. Management of anorectal melanoma is poorly described given the scarcity of the disease but typically consists of surgical resection, although the method and extent of resection is debated. Additionally, the benefit of adjuvant chemotherapy or radiation is unclear. Prognosis of anorectal melanoma is poor, with 5-year survival rates estimated to be no more than 20-30%.Figure 1.: (Left) A 0.8 × 0.5 × 0.1 cm anal mass was detected on colonoscopy. (Top, Right) Biopsy of .the anal mass was positive for immunostain HMB45. (Bottom, Right) Biopsy of the liver mass was positive for immunostain HMB45, suggestive of metastatic anorectal melanoma.

Anorectal melanoma: experience from a tertiary cancer care centre in South India.

Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Methods This study describes a retrospective analysis of 31 cases of anorectal melanoma presented to our centre between January 2001 and December 2013. Results Twenty-two patients (71%) presented with metastasis and had a median overall survival of nine months. None of the 22 patients survived for two years. Nine patients (29%) had curative surgery, in the form of abdominoperineal resection (six patients), abdominoperineal resection with bilateral inguinal node dissection (one patient), abdominoperineal resection with liver resection (one patient) and posterior exenteration (one patient). In patients who underwent curative surgery, the median overall survival was 15 months and disease-free survival was nine months, with a two-year overall survival of 22%. Conclusions Anorectal melanoma is an aggressive disease with a poor prognosis. The majority of patients present with distant metastases. Prognosis depends on stage at presentation. Early diagnosis and surgical resection may improve the overall outcome. Newer modalities such as immunotherapy and targeted therapies such as anti-CTLA4 monoclonal antibody and anti-programmed cell death protein 1 monoclonal antibodies have radically changed the management of mucosal melanoma and may, in the future, improve the overall prognosis of anorectal melanoma.

Incidence, Surgical Treatment, and Prognosis of Anorectal Melanoma From 1973 to 2011: A Population-Based SEER Analysis.

Anorectal melanoma (AM) is a rare type of melanoma that accounts for 0.4% to 1.6% of total malignant melanomas. The incidence of AM increases over time, and it remains highly lethal, with a 5-year survival rate of 6% to 22%. Considering the rare nature of this disease, most studies on AM comprise isolated case reports and single-center trials, which could not provide comprehensive assessment of the disease. Therefore, we conducted a population-based study by using the Surveillance, Epidemiology, and End Results (SEER) program to provide the latest and best available evidence of AM.We extracted all cases of AM registered in the SEER database from 1973 to 2011 (April 2014 release) and calculated age-adjusted incidence. Only cases with active follow-up were included to predict factors associated with prognosis. Survival outcomes were also compared among different types of surgery.We identified 640 AM cases, which consisted of 265 rectal melanoma and 375 anal melanoma. The estimated annual incidence rates of AM per 1 million population were 0.259 in males and 0.407 in females, and it increased with advanced age and over time. Tumor stage and surgical treatment were independent predictors of survival. Results implied that surgery improved the prognosis of patients with local- and regional-stage AM but could not prolong the survival of patients with distant-stage AM. Moreover, the outcome of less extensive excision was not statistically different from that of more extensive excision.This study provides an up-to-date estimation of the incidence and prognosis of AM by using SEER data. The incidence of AM continuously increases over time, despite its rarity. This disease also exhibits poor prognosis. Thus, AM must be further investigated in future studies. We also recommend surgery as the optimal treatment for local- and regional-stage AM patients but not for those with distant metastasis.

Management of Anorectal Melanoma: Report of 17 Cases and Literature Review

Primary anorectal melanoma is a rare and aggressive disease. It accounts for 0.5% of all rectal tumors. They are very agressive tumors with poor prognosis. The aim of this study is to report the clinical and evolutionary profile and therapeutical approach of these tumors. A retrospective study of 17 patients with anorectal melanoma diagnosed between January 1998 and December 2007 was performed. The signs and symptoms, diagnostic study, and surgical and medical treatments were analyzed. The average age was 58 years. Sex ratio was 12 men per five women. Patients had symptoms present for an average of 6 months. The most common symptom was rectal bleeding. According to Slingluff classification, five patients had stage I (localized tumor), four cases had stage II (regional nodes metastasis), and eight cases had stage III (distant metastasis). Seven patients have radical surgery. Only two patients received adjuvant immunotherapy. Eight patients received palliative chemotherapy based on dacarbazine or cisplatinum. The median survival was 8 months. Prognosis of anorectal melanoma is still very poor. However, some patients when treated by radical resection may experience long-term survival. The use of adjuvant immunotherapy needs large collaborative studies in view of the rarity of the tumor.

Anorectal melanoma in childhood and adolescence

The mucosal surfaces represent the third most common site of origin for melanoma, after the skin and ocular uveal tract. However, anorectal mucosal melanoma is a rare neoplasm, usually occurring in the sixth and seventh decades of life. It may often be confused clinically with other pathologic entities, such as prolapsed rectal polyps and hemorrhoids. The prognosis of anorectal melanoma is poor; this is at least in part attributable to the relatively large size that such tumors have frequently achieved at presentation, as well as their rich vascular network. In particular, anorectal melanoma in children and adolescents is extraordinarily uncommon. The authors herein report 2 examples of that tumor in 11-year-old and 19-year-old patients; one was alive and tumor-free after 6 years, whereas the other died with osseous and hepatic metastasis at the same time point. The authors emphasize the need for differential diagnostic inclusion of melanocytic malignancies when considering anorectal masses in pediatric individuals. Systematic collation and evaluation of pediatric melanomas of the anus and rectum are needed, to better define the biologic attributes of those neoplasms.

Mélanome anorectal primitif

To specify the clinical and therapeutic aspects of anorectal melanoma. Nine cases of malignant anorectal melanoma were managed in the department of gastroenterology of the Ibn Rochd university hospital in Casablanca between 1984 and 2002. There were 5 men and 4 women, with a mean age of 61 years. Clinical symptoms were dominated by rectal bleeding (7 cases) and rectal syndrome (5 cases). The tumor was blackish in 4 cases. Extension staging showed metastases in the liver in one patient and in the bones in another. One patient had undergone abdominoperineal resection, two transanal tumor resection, and in one patient radiotherapy was applied. Five patients refused any treatment. The outcome was marked by remission in 2 cases with an event free survival respectively of 10 and 21 months. Three patients died because of visceral metastases. Four patients were lost to follow-up. The prognosis of anorectal melanoma is frightening because of late diagnosis and high malignancy potential. Treatment is based essentially on surgery.