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Mattei J, Trindade EN, Chedid MF. Mucosal melanoma: from molecular landscape to current treatment strategies. Melanoma Res 2023; 33:447-453. [PMID: 37650711 DOI: 10.1097/cmr.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Mucosal melanoma (MM) is an aggressive tumor originating from melanocytes located in the respiratory, gastrointestinal, and urogenital tract with clinical and pathologic characteristics distinct from cutaneous melanoma. In addition, MMs have a unique biology that contributes to delayed diagnosis and, therefore an adverse prognosis. The factors all contribute to a treatment paradigm unique from its more studied cutaneous brethren. Due to the rarity of this disease, well-established protocols for the treatment of this pathology have yet to be established. The use of immune checkpoint inhibitors patterned after cutaneous melanoma has become the de facto primary therapeutic approach; however, cytotoxic strategies and pathway-targeted therapies have a defined role in treatment. Judicious use of these approaches can give rise to durable unmaintained disease responses.
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Affiliation(s)
- Jane Mattei
- Division of Medical Oncology, University of Texas, San Antonio, Texas, USA
| | - Eduardo N Trindade
- Division of Gastrointestinal Surgery and Liver Transplantation, Hospital de Clinicas de Porto Alegre, Medical School of UFRGS
| | - Marcio F Chedid
- Division of Gastrointestinal Surgery and Liver Transplantation, Hospital de Clinicas de Porto Alegre, Medical School of UFRGS
- Postgraduate Program in Surgical Sciences, Hospital de Clinicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
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2
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Alvarez J, Smith JJ. Anorectal mucosal melanoma. SEMINARS IN COLON AND RECTAL SURGERY 2023; 34:100990. [PMID: 38746826 PMCID: PMC11090490 DOI: 10.1016/j.scrs.2023.100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Anorectal mucosal melanoma accounts for less than 1 % of all anorectal malignant tumors and a tendency for delayed diagnosis leads to advanced disease at presentation.1,2 Due to the rarity of the disease, there are limited prospective trials exploring the optimal treatment strategies. Generally, tumors are surgically excised, with a preference for conservative management with wide local excision. In the past decade, there have been advances with immunotherapy and other targeted therapies. Multiple clinical trials continue exploring neoadjuvant/adjuvant combination treatments in the setting of advanced or unresectable disease.
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Affiliation(s)
- Janet Alvarez
- Research Scholar, Memorial Sloan Kettering Cancer Center, Department of Surgery, 1275 York Avenue | SR-201, New York, NY 10065, USA
| | - J. Joshua Smith
- Associate Member, Associate Attending Surgeon, Memorial Sloan Kettering Cancer Center, Colorectal Service, Department of Surgery, 1275 York Avenue, SR-201, New York, NY 10065, USA
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3
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Yan-Quiroz EF, Agreda-Castro FM, Diaz-Lozano L, Tenazoa-Villalobos R, Fernández-Rodríguez LJ. Management of primary anorectal mucosal melanoma during the COVID-19 pandemic. Ecancermedicalscience 2023; 17:1610. [PMID: 38414935 PMCID: PMC10898915 DOI: 10.3332/ecancer.2023.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Indexed: 02/29/2024] Open
Abstract
Anorectal melanoma is a rare and difficult-to-diagnose highly malignant cancer with a poor prognosis. The treatment usually involves surgery and often includes adjuvants such as radiation therapy and immunotherapy. We present a case of a 77-year-old Peruvian who was eventually diagnosed with this cancer during the COVID-19 pandemic, which complicated her treatment and allowed the cancer to spread. Her treatment included abdominoperineal resection, bilateral pelvic lymphadenectomy, left internal iliac vein raffia and end colostomy, followed by 3D radiation therapy (50 Gy, 25 sessions) and systemic treatment with nivolumab, all of which were well tolerated. The patient was alive as of 20 August 2023, having survived for more than 3 years since the onset of symptoms.
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Affiliation(s)
- Edgar Fermín Yan-Quiroz
- Hospital de Alta Complejidad Virgen de la Puerta - EsSalud, La Esperanza 13013, Perú
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- https://orcid.org/0000-0002-9128-4760
| | - Folker Mijaíl Agreda-Castro
- Hospital de Alta Complejidad Virgen de la Puerta - EsSalud, La Esperanza 13013, Perú
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- https://orcid.org/0000-0003-4057-6365
| | - Lita Diaz-Lozano
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- Hospital Víctor Lazarte Echegaray - EsSalud, Trujillo 13006, Perú
- https://orcid.org/0000-0003-2842-369X
| | - Richard Tenazoa-Villalobos
- Hospital de Alta Complejidad Virgen de la Puerta - EsSalud, La Esperanza 13013, Perú
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- https://orcid.org/0000-0003-3622-9408
| | - Lissett Jeanette Fernández-Rodríguez
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- Hospital Regional de Lambayeque - Ministerio de Salud, Chiclayo 14012, Perú
- https://orcid.org/0000-0002-4357-4261
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4
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Mercurio AC, Maniar AB, Wei AZ, Carvajal RD. Targeting the IL-2 pathway for the treatment of mucosal melanoma. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2134776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ann C. Mercurio
- Columbia University Irving Medical Center Department of Medicine, Division of Hematology & Oncology, 177 Fort Washington Avenue, 10032, New York, NY, USA
- New York Medical College, School of Medicine, 40 Sunshine Cottage Road, 10595, Valhalla, NY, USA
| | - Ashray B. Maniar
- Columbia University Irving Medical Center Department of Medicine, Division of Hematology & Oncology, 177 Fort Washington Avenue, 10032, New York, NY, USA
| | - Alexander Z. Wei
- Columbia University Irving Medical Center Department of Medicine, Division of Hematology & Oncology, 177 Fort Washington Avenue, 10032, New York, NY, USA
| | - Richard D. Carvajal
- Columbia University Irving Medical Center Department of Medicine, Division of Hematology & Oncology, 177 Fort Washington Avenue, 10032, New York, NY, USA
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5
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Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas. Biomedicines 2022; 10:biomedicines10010150. [PMID: 35052829 PMCID: PMC8773579 DOI: 10.3390/biomedicines10010150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Mucosal melanomas (MM) are rare tumors, being less than 2% of all diagnosed melanomas, comprising a variegated group of malignancies arising from melanocytes in virtually all mucosal epithelia, even if more frequently found in oral and sino-nasal cavities, ano-rectum and female genitalia (vulva and vagina). To date, there is no consensus about the optimal management strategy of MM. Furthermore, the clinical rationale of molecular tumor characterization regarding BRAF, KIT or NRAS, as well as the therapeutic value of immunotherapy, chemotherapy and targeted therapy, has not yet been deeply explored and clearly established in MM. In this overview, focused on anorectal and genital MM as models of rare melanomas deserving of a multidisciplinary approach, we highlight the need of referring these patients to centers with experts in melanoma, anorectal and uro-genital cancers treatments. Taking into account the rarity, the poor outcomes and the lack of effective treatment options for MM, tailored research needs to be promptly promoted.
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6
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Singh BK, Ray S, Dhawan S, Nundy S. Spectrum of presentation in primary anorectal malignant melanoma and its management. BMJ Case Rep 2021; 14:e245449. [PMID: 34598968 PMCID: PMC8488700 DOI: 10.1136/bcr-2021-245449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/03/2022] Open
Abstract
The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is to give an overview of the variable presentation of this rare entity from a high-volume colorectal tertiary care centre in a developing country. The patients ranged in age from 55 to 73 years and were mostly women (except one). The clinical presentation varied from bleeding per rectum to tenesmus and mucus in stools, overlapping with those of inflammatory bowel disease and primary anorectal adenocarcinoma. All patients were treated with surgery (laparoscopic or open), ranging from local excision to abdominoperineal resection. All our patients had a good outcome after surgery with no mortality at 30 or 90 days after surgery. The article aims to present a comprehensive overview of the various options of management with evidence from the surgical literature.
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Affiliation(s)
- Barun Kumar Singh
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Samrat Ray
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Pathology/Histopathology Unit, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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7
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Fatudimu SO, Omoseebi O, Babalola OF, Akanni SO. Anal Melanoma: A Case Report of a Rare and Lethal Malignancy in a Suburban Nigerian Teaching Hospital. Niger J Surg 2021; 27:59-62. [PMID: 34012244 PMCID: PMC8112359 DOI: 10.4103/njs.njs_63_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this report is to highlight the challenges involved in the diagnosis and treatment of anal melanoma in a tertiary hospital in Nigeria. It is a case report of an 84-year-old man who was managed for anal malignant melanoma. Despite inadequate investigative tools and less radical surgical treatment, the survival period of the index patient was comparable to the median survival quoted in the literature. Despite its rarity, mucosal melanomas also occur in the tropics. Prompt diagnosis, adequate imaging, and standardized treatment may improve its outlook in the nearest future.
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Affiliation(s)
- Samuel Oluwafemi Fatudimu
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria.,Department of Surgery, Afe-Babalola College of Medicine and Health Sciences, Ado-Ekiti, Ekiti State, Nigeria
| | - Oladipo Omoseebi
- Department of Histopathology, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria.,Department of Anatomic Pathology, College of Medicine and Health Sciences, Afe-Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Olakunle Fatai Babalola
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria.,Department of Surgery, Afe-Babalola College of Medicine and Health Sciences, Ado-Ekiti, Ekiti State, Nigeria
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8
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Bleicher J, Cohan JN, Huang LC, Peche W, Pickron TB, Scaife CL, Bowles TL, Hyngstrom JR, Asare EA. Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature. World J Gastroenterol 2021; 27:267-280. [PMID: 33519141 PMCID: PMC7814367 DOI: 10.3748/wjg.v27.i3.267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anorectal melanoma (ARM) is a rare disease with a poor prognosis. Evidence on optimal treatment is limited and surgical management varies widely. We hypothesized that the frequency of abdominoperineal resection used as primary treatment of ARM has decreased over the past several decades.
AIM To update our understanding of outcomes for patients with ARM and analyze management trends around the world.
METHODS This is a multi-institutional, retrospective study of patients treated for ARM at 7 hospitals. Hospitals included both large, academic, tertiary care centers and smaller, general community hospitals. Using prospectively maintained institutional tumor registries, we identified 24 patients diagnosed with ARM between January 2000 and May 2019. We analyzed factors prognostic for recurrence and survival. We then used Cox regression to measure overall survival (OS) and melanoma-specific survival. We also performed a literature review to assess trends in surgical management and outcomes.
RESULTS Of the 24 patients diagnosed with ARM, 12 (50.0%) had local, 8 (33.3%) regional, and 4 (16.7%) distant disease at diagnosis. Median time to recurrence was 10.4 mo [interquartile range (IQR) 7.5-17.2] with only 2 patients (9.3%) not developing recurrence following surgical resection. Median OS was 18.8 mo (IQR 13.5-33.9). One patient is still alive without recurrence at 21.4 mo from diagnosis; no other patient survived 5 years. Primary surgical management with abdominoperineal resection (APR) vs wide excision (WE) did not lead to differences in OS [hazard ratio = 1.4 (95%CI: 0.3-6.8)]. Review of the literature revealed geographic differences in surgical management of ARM, with increased use of WE in the United States and Europe over time and more frequent use of APR in Asia and India. There was no significant improvement in survival over time.
CONCLUSION There is wide variation in the management of ARM and survival outcomes remain poor regardless of approach. Surgical management should aim to minimize morbidity.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Jessica N Cohan
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Lyen C Huang
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - William Peche
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84114, United States
| | - T Bartley Pickron
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Courtney L Scaife
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Tawnya L Bowles
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, Intermountain Medical Center, Murray, UT 84107, United States
| | - John R Hyngstrom
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84114, United States
| | - Elliot A Asare
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, Intermountain Medical Center, Murray, UT 84107, United States
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9
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Yan X, Sheng X, Chi Z, Si L, Cui C, Kong Y, Tang B, Mao L, Wang X, Lian B, Li S, Bai X, Zhou L, Dai J, Yao H, Guo J. Randomized Phase II Study of Bevacizumab in Combination With Carboplatin Plus Paclitaxel in Patients With Previously Untreated Advanced Mucosal Melanoma. J Clin Oncol 2021; 39:881-889. [PMID: 33444116 DOI: 10.1200/jco.20.00902] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Mucosal melanoma (MM) is a highly vascularized tumor with an extremely poor prognosis. In this randomized, open-label, phase II study, we characterized the efficacy and safety of bevacizumab in combination with carboplatin plus paclitaxel (CPB) in patients with previously untreated advanced MM. PATIENTS AND METHODS Patients were randomly assigned in a 2:1 ratio to receive carboplatin (area under the curve, 5) plus paclitaxel (175 mg/m2) once every 4 weeks in combination with (CPB arm, 5 mg/kg) or without (CP arm) bevacizumab once every 2 weeks. Progression-free survival (PFS) was the primary end point. Secondary end points included overall survival (OS), objective response rate, and adverse events. RESULTS We recruited 114 patients to our study. The median PFS was significantly longer in the CPB arm (4.8 months; 95% CI, 3.6 to 6.0 months) than in the CP arm (3.0 months; 95% CI, 1.7 to 4.3 months) (hazard ratio, 0.461; 95% CI, 0.306 to 0.695; P < .001). Objective response rates were 19.7% and 13.2%, respectively (P = .384). The median OS was also significantly longer in the CPB arm than in the CP arm (13.6 v 9.0 months; hazard ratio, 0.611; 95% CI, 0.407 to 0.917; P = .017). No new safety signals were observed. CONCLUSION PFS and OS were significantly better in patients with metastatic MM who received bevacizumab in addition to CPB than in those who received CPB alone. A phase III study should be performed to confirm these benefits (ClinicalTrials.gov identifier: NCT02023710).
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Affiliation(s)
- Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hong Yao
- Department of Cancer Biotherapy, Third Affiliated Hospital of Kunming School of Medicine, Kunming, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
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10
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Sahu A, Ramaswamy A, Singhal N, Doshi V, Mirani J, Desouza A, Banavali S, Saklani A, Ostwal V. Metastatic anorectal melanomas - An exploratory retrospective analysis on the benefits of systemic therapy versus best supportive care in a resource-limited setting from India. South Asian J Cancer 2020; 6:147-150. [PMID: 29404289 PMCID: PMC5763621 DOI: 10.4103/sajc.sajc_276_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aim Data regarding the optimal management of metastatic anorectal melanoma (mARM) is scarce. The primary aim was to evaluate the potential benefits of systemic therapy in mARM. Materials and Methods This is a retrospective analysis of all mARM who presented between July 2013 and June 2015 at the Department of GI Medical Oncology, Tata Memorial Hospital. Results Of a total of 37 patients, twelve patients were planned for best supportive care (BSC) only while the remaining 25 patients received systemic therapy. The median overall survival (OS) for the whole cohort was 27 weeks. The OS was significantly better in patients who received first-line therapy as compared to those who were offered BSC (median OS: 14 vs. 33 weeks; P = 0.04). Patients with PS of 1 did significantly better than PS of 2 more (OS 70 vs. 17 weeks; P = 0.015). Conclusion mARM should be offered chemotherapy, especially in good performance patients. Paclitaxel/Platinum or Capecitabine/Temozolomide regimens can be considered as the preferred regime in the resource-limited setting where immunotherapy may not be a feasible option.
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Affiliation(s)
- Arvind Sahu
- Department of Medical Oncology, TMH, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, TMH, Mumbai, Maharashtra, India
| | - Nitin Singhal
- Department of Surgical Oncology, TMH, Mumbai, Maharashtra, India
| | - Vipul Doshi
- Department of Medical Oncology, TMH, Mumbai, Maharashtra, India
| | - Jimmy Mirani
- Department of Medical Oncology, TMH, Mumbai, Maharashtra, India
| | - Ashwin Desouza
- Department of Surgical Oncology, TMH, Mumbai, Maharashtra, India
| | | | - Avanish Saklani
- Department of Surgical Oncology, TMH, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, TMH, Mumbai, Maharashtra, India
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11
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Yeung HM, Gupta B, Kamat B. A Rare Case of Primary Anorectal Melanoma and a Review of the Current Landscape of Therapy. J Community Hosp Intern Med Perspect 2020; 10:371-376. [PMID: 32850102 PMCID: PMC7427446 DOI: 10.1080/20009666.2020.1787809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/23/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Anorectal mucosal melanoma (ARMM) is an uncommon and highly aggressive malignancy. Given its rarity, there is insufficient evidence on the optimal medical management which presents as a clinical challenge to its diagnosis and treatment. Treatment of ARMM typically involves a multimodal approach including surgical resection, chemotherapy, targeted therapy and/or immunotherapy. CASE PRESENTATION Here, we present a case of a 78-year-old female who presented with a four-month history of rectal bleeding and bowel incontinence. Ultimately, colonoscopy revealed a mass at the anal verge, and biopsy of the mass showed malignant cells that stained positive for S100, Melan-A and HMB-45, consistent with the diagnosis of malignant melanoma. Molecular testing revealed no BRAF, KIT or NRAS gene mutations. PD-L1 immunohistochemistry showed tumor proportion score of 1%. She underwent abdominoperineal resection with a plan to initiate immunotherapy with an anti-PD-1 checkpoint inhibitor. This case highlights a rare aggressive malignancy and reviews its treatment option, which are mostly extrapolated from its cutaneous counterpart and some derived from a few case reports. Due to its rarity, there is no consensus guideline for the treatment of ARMM.
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Affiliation(s)
- Ho-Man Yeung
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Brinda Gupta
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Bhishak Kamat
- Department of Radiology, Temple University Hospital, Philadelphia, PA, USA
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12
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Metildi C, McLemore EC, Tran T, Chang D, Cosman B, Ramamoorthy SL, Saltzstein SL, Sadler GR. Incidence and Survival Patterns of Rare Anal Canal Neoplasms Using the Surveillance Epidemiology and End Results Registry. Am Surg 2020. [DOI: 10.1177/000313481307901023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Small cell, neuroendocrine tumors, and melanoma of the anus are rare. Limited data exist on the incidence and management for these rare tumors. A large, prospective, population-based database was used to determine incidence and survival patterns of rare anal neoplasms. The Surveillance, Epidemiology and End Results registry was queried to identify patients diagnosed with anal canal neoplasms. Incidence and survival patterns were evaluated with respect to age, sex, race, histology, stage, and therapy. We identified 7078 cases of anal canal neoplasms: melanoma (n = 149), neuroendocrine (n = 61), and small cell neuroendocrine (n = 26). Squamous cell carcinoma (SCC) (n = 6842) served as the comparison group. Anal melanoma (AM) demonstrated the lowest survival rate at 2.5 per cent. Neuroendocrine tumors (NETs) demonstrated similar survival as SCC (10-year survival for regional disease of 25 and 22.3%, respectively). Ten-year survival of small cell NETs resembled AM (5.3 vs 2.5%). Age 60 years or older, sex, black race, stage, and surgery were independent predictors of survival. This study presents the largest patient series of rare anal neoplasms. NETs of the anal canal demonstrate similar survival patterns to SCC, whereas small cell NETs more closely resemble AM. Accurate histologic diagnosis is vital to determine treatment and surgical management because survival patterns can differ among rare anal neoplasms.
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Affiliation(s)
- Cristina Metildi
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
| | - Elisabeth C. McLemore
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
- Moores UCSD Cancer Center, University of California San Diego, San Diego, California
| | - Thuy Tran
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
| | - David Chang
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
| | - Bard Cosman
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
| | - Sonia L. Ramamoorthy
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
- Moores UCSD Cancer Center, University of California San Diego, San Diego, California
| | - Sidney L. Saltzstein
- Department of Family Medicine and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
- Moores UCSD Cancer Center, University of California San Diego, San Diego, California
| | - Georgia Robins Sadler
- From the Departments of Surgery and Preventive Medicine, Department of Pathology, University of California, San Diego, San Diego, California
- Moores UCSD Cancer Center, University of California San Diego, San Diego, California
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13
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Singh S, Lohia N, Prashar M, Harish S, Subramananiam A, Viswanath S, Ranjan R, Trivedi G. Primary anorectal melanoma: Multimodality management in a series of four cases and review of literature. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2020. [DOI: 10.4103/mjmsr.mjmsr_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Efficacy of Immunotherapy in Patients with Metastatic Mucosal or Uveal Melanoma. JOURNAL OF ONCOLOGY 2018; 2018:1908065. [PMID: 30631354 PMCID: PMC6304636 DOI: 10.1155/2018/1908065] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/09/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
Background The objective was to assess the response rate and survival of patients with metastatic mucosal melanoma (MM) and uveal melanoma (UM) treated with anti-CTLA-4 or anti-PD-1 monoclonal antibodies (mAbs). Methods A multicenter retrospective study was performed in 25 dermatology departments in France. All patients with stage III-C to IV MM or UM who were treated with anti-CTLA-4 or anti-PD-1 mAbs between 2008 and 2016 were included and compared after adjustment for main prognostic factors with a second cohort of patients treated with chemotherapy. Tumor response was evaluated according to RECIST v. 1.1 criteria at Week 12. Results Four-hundred-and-thirty-nine patients were included, 229 MM (151 immunotherapy, 78 chemotherapy) and 210 UM (100 immunotherapy, 110 chemotherapy). Response rates of MM patients treated with immunotherapy were 18/151 (11.9%; 95% CI:7.2%-18.2%), versus 11/78 (14.1%, 95% CI:7.3%-23.8%) in patients treated with chemotherapy (p=0.87). No tumor response was observed in UM patients treated with immunotherapy, versus 4/110 responses (3.6%, 95% CI:1.0-9.0%) in patients treated with chemotherapy (p=0.15). The adjusted overall survival (OS) of MM patients treated with immunotherapy was longer than that of patients treated with chemotherapy HR=0.62 (95% CI: 0.43-0.91), p=0.014, with an unadjusted median OS of 15.97 months [interquartile range (IQR)=6.89-27.11] and 8.82 months [IQR=5.02-14.92], respectively. The adjusted OS of UM patients treated with immunotherapy was not significantly different from that of patients treated with chemotherapy (HR=0.98, 95% CI: 0.66-1.44) p=0.92, with an unadjusted median OS of 13.38 months [IQR=6.03-29.57] and 11.02 months [IQR=6.13-23.93], respectively. Conclusion Immunotherapy significantly improves OS for MM. The prognosis of metastatic UM remains poor.
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Clinical features and response to systemic therapy in a historical cohort of advanced or unresectable mucosal melanoma. Melanoma Res 2018; 27:57-64. [PMID: 27792058 DOI: 10.1097/cmr.0000000000000306] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There are very few data available regarding the pattern of first metastases in resected mucosal melanomas (MMs) as well as the response of advanced MM to cytotoxic therapy. A retrospective, single-institution cohort was assembled of all patients with advanced/unresectable MM between 1995 and 2012 who had received systemic therapy with available imaging (N=81). Responses to first-line and second-line systemic therapy were assessed using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The relationship between response, overall survival, and clinical covariates was investigated using Cox proportional hazards regression. Primary sites included anorectal (N=31, 38%), vulvovaginal (N=28, 35%), head and neck (N=21, 26%), and gallbladder (N=1, 1%) mucosa. Seven percent of patients had their first relapse in the brain. Cytotoxic therapy represented 82 and 51% of first-line and second-line regimens. The best response achieved in the first-line setting was similar for single-agent [10%; 95% confidence interval (CI): 1-32%] and combination alkylator therapy (8%; 95% CI: 2-21%). Median overall survival from first-line treatment was 10.3 months (95% CI: 8.7-13.9 months). Patients with elevated lactic dehydrogenase [hazard ratio (HR): 1.87, 95% CI: 1.10-3.19, P=0.020] and Eastern Cooperative Oncology Group performance status 1-2 (HR: 1.69, 95% CI: 1.05-2.72, P=0.030) had a higher risk of death, whereas patients with 12-week objective responses had a lower risk of death (HR: 0.12, 95% CI: 0.04-0.41, P<0.001). Cytotoxic systemic therapy has modest activity in advanced/unresectable MM, belying its adjuvant benefit. Patients whose tumors have an objective response to therapy have a lower probability of death. Brain imaging should be considered in routine surveillance.
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Shen S, Yang J, Carvajal RD. Mucosal melanoma: epidemiology, biology, management and the role of immunotherapy. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1399122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sherry Shen
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Jessica Yang
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Richard D. Carvajal
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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17
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Jensen C, Kin C. Black Is the New Black: Prolapsing Primary Anorectal Melanoma. Dig Dis Sci 2017; 62:2991-2993. [PMID: 28289926 DOI: 10.1007/s10620-017-4527-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Christopher Jensen
- Department of Surgery, Section of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Cindy Kin
- Department of Surgery, Section of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA. .,Stanford University Medical Center, 300 Pasteur Drive, H3680K, Stanford, CA, 94305, USA.
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18
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Ciarrocchi A, Pietroletti R, Carlei F, Amicucci G. Extensive surgery and lymphadenectomy do not improve survival in primary melanoma of the anorectum: results from analysis of a large database (SEER). Colorectal Dis 2017; 19:158-164. [PMID: 27317493 DOI: 10.1111/codi.13412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/17/2016] [Indexed: 12/24/2022]
Abstract
AIM Primary anorectal melanoma is a rare disease with a dismal prognosis due to early distant metastasis. The prognostic value of positive loco-regional lymph nodes and the impact of lymphadenectomy on overall survival are unclear. We have investigated this by analysis of data obtained from a national representative database, controlling for potential confounders. METHODS Data were retrieved from the Surveillance, Epidemiology and End Results (SEER) database. Multiple imputation analysis was performed to deal with missing data. Cox regression models were formulated using different prognostic factors including site of origin, gender, size, race, rate of lymph node metastasis (ratio between positive lymph node count and total lymph nodes harvested), extent of lymphadenectomy (none, level I etc.), age, type of surgery, stage of disease and administration of radiotherapy. RESULTS Our population was composed of 208 patients who underwent surgery between 1998 and 2012. Rate of lymph node metastasis (P = 0.027; hazard ratio 1.873, 95% CI 1.076-3.261) and race (P = 0.019; hazard ratio 2.291, 95% CI 1.148-4.575) were found to be independent predictors of survival. CONCLUSION Based on the data retrieved from the SEER database, metastasis to loco-regional lymph nodes is an important prognostic factor, but lymphadenectomy does not improve survival.
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Affiliation(s)
- A Ciarrocchi
- General and Emergency Surgery, University of L'Aquila, L'Aquila, Italy
| | - R Pietroletti
- Coloproctological Surgery University of L'Aquila, Hospital Val Vibrata, Sant'Omero (TE), Italy
| | - F Carlei
- Postgraduate School of Digestive Surgery, University of L'Aquila, L'Aquila, Italy
| | - G Amicucci
- General and Emergency Surgery, University of L'Aquila, L'Aquila, Italy
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Shoushtari AN, Munhoz RR, Kuk D, Ott PA, Johnson DB, Tsai KK, Rapisuwon S, Eroglu Z, Sullivan RJ, Luke JJ, Gangadhar TC, Salama AKS, Clark V, Burias C, Puzanov I, Atkins MB, Algazi A, Ribas A, Wolchok JD, Postow MA. The efficacy of anti-PD-1 agents in acral and mucosal melanoma. Cancer 2016; 122:3354-3362. [PMID: 27533633 PMCID: PMC5134420 DOI: 10.1002/cncr.30259] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Therapeutic antibodies against programmed cell death receptor 1 (PD-1) are considered front-line therapy in metastatic melanoma. The efficacy of PD-1 blockade for patients with biologically distinct melanomas arising from acral and mucosal surfaces has not been well described. METHODS A multi-institutional, retrospective cohort analysis identified adults with advanced acral and mucosal melanoma who received treatment with nivolumab or pembrolizumab as standard clinical practice through expanded access programs or published prospective trials. Objective responses were determined using investigator-assessed Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Progression-free survival and overall survival were assessed using the Kaplan-Meier method. RESULTS Sixty individuals were identified, including 25 (42%) with acral melanoma and 35 (58%) with mucosal melanoma. Fifty-one patients (85%) had received previous therapy, including 77% who had previously received ipilimumab. Forty patients (67%) received pembrolizumab at a dose of 2 mg/kg or 10 mg/kg, and 20 (33%) received nivolumab at a doses ranging from 0.3 to 10 mg/kg every 2 to 3 weeks. The objective response rate was 32% (95% confidence interval, 15%-54%) in patients with acral melanoma and 23% (95% confidence interval, 10%-40%) in those with mucosal melanoma. After a median follow-up of 20 months in the acral melanoma group and 10.6 months in the mucosal melanoma group, the median progression-free survival was 4.1 months and 3.9 months, respectively. Only 2 patients (3%) discontinued treatment because of toxicity. CONCLUSIONS Response rates to PD-1 blockade in patients with acral and mucosal melanomas were comparable to the published rates in patients with cutaneous melanoma and support the routine use of PD-1 blockade in clinical practice. Further investigation is needed to identify the mechanisms of response and resistance to therapy in these subtypes. Cancer 2016;122:3354-3362. © 2016 American Cancer Society.
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Affiliation(s)
- Alexander N. Shoushtari
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, U.S.A,Weill Cornell Medical College, New York, U.S.A
| | - Rodrigo R. Munhoz
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, U.S.A
| | - Deborah Kuk
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York U.S.A
| | - Patrick A. Ott
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, U.S.A
| | - Douglas B. Johnson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, U.S.A
| | - Katy K. Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, U.S.A
| | - Suthee Rapisuwon
- Georgetown Lombardi Comprehensive Cancer Center, Washington, U.S.A
| | | | - Ryan J. Sullivan
- Massachussetts General Hospital, Harvard Medical School, Boston, U.S.A
| | - Jason J. Luke
- University of Chicago Comprehensive Cancer Center, Chicago, U.S.A
| | - Tara C. Gangadhar
- Abramson Cancer Center, University of Pennsylvania Philadelphia, U.S.A
| | | | - Varina Clark
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, U.S.A
| | - Clare Burias
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, U.S.A
| | - Igor Puzanov
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, U.S.A
| | | | - Alain Algazi
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, U.S.A
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, U.S.A
| | - Jedd D. Wolchok
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, U.S.A,Weill Cornell Medical College, New York, U.S.A
| | - Michael A. Postow
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, U.S.A,Weill Cornell Medical College, New York, U.S.A
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Peña D, O'Hara K, Romero V, García-Alhambra MÁ. [Anorectal melanoma in a nonagenarian patient]. Rev Esp Geriatr Gerontol 2016; 51:299-301. [PMID: 26908074 DOI: 10.1016/j.regg.2015.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Daiana Peña
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Kevin O'Hara
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Vicente Romero
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Dominiak NR, Wick MR, Smith MT. Mucosal melanomas: Site-specific information, comparisons with cutaneous tumors, and differential diagnosis. Semin Diagn Pathol 2016; 33:191-7. [DOI: 10.1053/j.semdp.2016.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Mucosal melanoma is an exceedingly rare variant of cutaneous melanoma that, due to its rarity, is poorly described and infrequently studied. Primary sites of origin include the head and neck, anorectum and vulvovaginal regions. It is uniquely different from cutaneous melanoma with respect to epidemiology, etiology, pathogenesis and prognosis. The etiology and pathogenesis remain unclear. Unlike cutaneous melanoma, exposure to UV light is not an apparent risk factor. Furthermore, distinct molecular features including a lower incidence of BRAF oncogene mutations but a higher incidence of KIT oncogene mutations suggest divergent genetic etiologies. Mucosal melanomas generally present at a later stage, are more aggressive and carry a worse prognosis regardless of the stage at diagnosis. Establishing standardized treatment guidelines has been challenging due to the rarity of the disease. Early detection provides the best chance at survival but is often difficult due to anatomic location. Surgery remains the primary therapeutic intervention if complete resection is technically feasible given the anatomic location. Radiotherapy may be used to achieve local control when resection is not feasible, or adjuvantly to enhance locoregional control, but most studies have failed to demonstrate an improvement in overall survival. There are no consensus guidelines on the optimal systemic therapy, and regimens are often extrapolated from data based on therapies used to treat advanced cutaneous melanoma. Clinical trials, particularly utilizing newer targeted therapies and immunotherapies, are investigating novel treatment approaches.
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23
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Moukhlissi M, Derouich H, Majdoul S, Naoumi S, Bennani N, Karkouri M, Haddad F, Badre W, Benider A. [Primitive anorectal melanoma]. Pan Afr Med J 2015; 21:65. [PMID: 26405501 PMCID: PMC4564426 DOI: 10.11604/pamj.2015.21.65.6838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/29/2015] [Indexed: 11/13/2022] Open
Abstract
Nous proposons une étude rétrospective réalisée au sein du département de gastro-entérologie et d'Oncologie du CHU Casablanca colligeant tous les cas des mélanomes ano-rectaux primitifs, sur une période de 15 ans (du 1997 au 2012). Notre série comportait 14 patients, 8 hommes et 6 femmes avec une moyenne d’âge de 60,5 ans. Les signes cliniques étaient dominés par les rectorragies et le syndrome rectal (plus de 80% des malades). L'aspect tumoral noirâtre à été noté chez la moitié des malades. L'examen endoscopique a révélé une prédominance des lésions ulcéro-bourgeonnantes. Dans 5 cas la tumeur était plus haut située entre 5 à 8 cm de la marge anale. Le bilan d'extension avait décelé des métastases ganglionnaires, osseuses ou viscérales chez 7 malades. Un traitement chirurgical a été pratiqué chez 50% des malades (7 cas). Il a consisté en une exérèse locale isolée (2 cas) ou associée à une radiothérapie (2 cas) et une amputation abdomino-périnéale dans 3 cas. Quatre malades ont reçu une chimiothérapie et/ou radiothérapie palliative et dans deux cas on s'est contenté d'un traitement symptomatique. L’évolution a été marquée par une récidive chez les 2 patients traités par exérèse locale, dont un a été bénéficié d'une amputation abdomino-pelvienne de rattrapage et un des trois patients traités par chirurgie radicale. Deux patients sont en rémission complète après 36 mois de recul.
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Affiliation(s)
| | - Hasna Derouich
- Departement de Gastro-Entérologie, CHU Ibn Rochd, Casablanca, Maroc
| | - Soufia Majdoul
- Departement d'Oncologie, CHU Ibn Rochd, Casablanca, Maroc
| | - Sanaa Naoumi
- Departement d'Anatomopathologie, CHU Ibn Rochd, Casablanca, Maroc
| | | | - Mehdi Karkouri
- Departement d'Anatomopathologie, CHU Ibn Rochd, Casablanca, Maroc
| | - Fouad Haddad
- Departement de Gastro-Entérologie, CHU Ibn Rochd, Casablanca, Maroc
| | - Wafaa Badre
- Departement de Gastro-Entérologie, CHU Ibn Rochd, Casablanca, Maroc
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Stefanou AJ. Anorectal melanoma. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma: a systematic review. Ann Surg 2015; 261:670-7. [PMID: 25119122 DOI: 10.1097/sla.0000000000000862] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM). BACKGROUND 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. METHODS 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). RESULTS 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 and LE groups. APR significantly reduced local recurrence compared with LE (OR, 0.18; 95% CI, 0.09-0.36; P < 0.00001). CONCLUSIONS Although several limitations, such as inclusion of only retrospective studies with relatively small sample size and selection biases for surgical procedure, are involved, this meta-analysis suggested that APR has no survival benefit; however, APR confers better local control than LE. Given that local failures after LE could be managed by salvage surgery, minimizing morbidity and maximizing quality of life should be the focus in surgical treatment of ARMM.
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Ballester Sánchez R, de Unamuno Bustos B, Navarro Mira M, Botella Estrada R. Actualización en melanoma mucoso. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:96-103. [DOI: 10.1016/j.ad.2014.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/17/2014] [Accepted: 04/21/2014] [Indexed: 02/01/2023] Open
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Ballester Sánchez R, de Unamuno Bustos B, Navarro Mira M, Botella Estrada R. Mucosal Melanoma: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Abstract
Since the development and approval of Ipilimumab, the first immune checkpoint inhibitor licensed for the treatment of metastatic melanoma, clinicians have gained a better understanding of the mode of action, management of toxicities, and assessment of response to this class of drugs. Several antibodies are now in development, aimed at blocking novel immune checkpoint molecules, such as PD-1 and it's corresponding ligand PD-L1. This article summarizes the mechanism of action, preclinical development, and subsequent clinical studies of immune checkpoint antibodies in melanoma.
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Affiliation(s)
- Jarushka Naidoo
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - David B Page
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jedd D Wolchok
- Melanoma and Immunotherapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Ludwig Center for Cancer Immunotherapy, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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29
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Reina A, Errasti J, Espín E. Melanoma anorrectal. Revisión de conjunto. Cir Esp 2014; 92:510-6. [DOI: 10.1016/j.ciresp.2013.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 12/12/2022]
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Nam S, Kim CW, Baek SJ, Hur H, Min BS, Baik SH, Kim NK. The clinical features and optimal treatment of anorectal malignant melanoma. Ann Surg Treat Res 2014; 87:113-7. [PMID: 25247163 PMCID: PMC4170582 DOI: 10.4174/astr.2014.87.3.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/30/2014] [Accepted: 03/31/2014] [Indexed: 12/21/2022] Open
Abstract
Anorectal malignant melanoma (AMM) is a very rare and aggressive disease. The purpose of this article is to review the clinical features of AMM, to understand treatment options, and optimal therapy by reviewing pertinent literature. Traditionally an abdominoperineal resection (APR) sacrificing the anal sphincter has been performed for radical resection of cancer, but recently, wide excision of AMM is attempted since quality of life after surgery is an important issue. Some authors reported that there was no difference in five-year survival between the patient who underwent an APR and wide excision. The goal of both APR and wide excision was to improve survival with R0 resection. Adjuvant chemoradiation therapy can be performed to achieve an R0 resection. AMM shows very poor prognosis. At this time, research on AMM is insufficient to suggest a treatment guideline. Thus, treatment options, and a therapeutic method should be selected carefully.
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Affiliation(s)
- Soomin Nam
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Woo Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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32
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Update on primary mucosal melanoma. J Am Acad Dermatol 2014; 71:366-75. [PMID: 24815565 DOI: 10.1016/j.jaad.2014.03.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/10/2014] [Accepted: 03/15/2014] [Indexed: 12/11/2022]
Abstract
Mucosal melanomas are aggressive cancers of mucosal surfaces with clinical and pathologic characteristics distinct from cutaneous melanomas, warranting different staging systems and treatment approaches. Surgical resection is performed frequently for the primary tumor, although the utility of lymph node surgery and radiation therapy is not established. Therapies targeted against C-KIT activating mutations, identified in many mucosal melanomas, are emerging as promising treatments.
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33
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Khan M, Bucher N, Elhassan A, Barbaryan A, Ali AM, Hussain N, Mirrakhimov AE. Primary anorectal melanoma. Case Rep Oncol 2014; 7:164-70. [PMID: 24748866 PMCID: PMC3985785 DOI: 10.1159/000360814] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary malignant melanoma of the anus and rectum is a rare and aggressive neoplasm that tends to invade locally and metastasize early in the course of the disease. It is often misdiagnosed as hemorrhoids or as one of the other benign anorectal conditions and is thus linked to an overall poor prognosis and a 5-year survival rate of less than 20%. Optimal treatment is still controversial, and current evidence does not show any preferential survival benefit from abdominoperineal resection over wide local excision. Chemotherapy or radiotherapy may be used for advanced disease. We report a 71-year-old female presenting with painful bowel movements and blood in stools. She was eventually found to have a mass arising from the anorectal junction with regional lymph node involvement. The patient underwent an abdominoperineal resection and is currently scheduled for chemotherapy.
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Affiliation(s)
- Maliha Khan
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
| | - Nora Bucher
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
| | - Ahmed Elhassan
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
| | - Aram Barbaryan
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
| | - Alaa M Ali
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
| | - Nasir Hussain
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
| | - Aibek E Mirrakhimov
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Ill., USA
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Ling TC, Slater JM, Senthil M, Kazanjian K, Howard F, Garberoglio CA, Slater JD, Yang GY. Surgical and radiation therapy management of recurrent anal melanoma. J Gastrointest Oncol 2014; 5:E7-E12. [PMID: 24490051 DOI: 10.3978/j.issn.2078-6891.2013.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/15/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Melanoma of the anorectal mucosa is a rare but highly aggressive tumor. Its presenting symptoms are frequently confused with hemorrhoids, thereby causing a delay in diagnosis. Anorectal melanoma carries with it a very poor prognosis. There is a paucity of data investigating management options for anorectal melanoma, and even fewer data reporting recurrent or refractory cases. CASE PRESENTATION This case documents a 41-year-old female with a long history of hemorrhoids presenting with anorectal discharge. She was incidentally found have anorectal melanoma following surgical resection. Systemic diagnostic work-up demonstrated PET-avid lymphadenopathy in her right groin. She underwent right groin dissection. However, seven months later she recurred in her right groin and a new recurrent mass was found in her pelvis. She underwent a second groin dissection and resection of the pelvic recurrence. This was followed by a course of hypofractionated radiation therapy then systemic immunotherapy. DISCUSSION Surgery has been the mainstay of treatment. However, the extent of surgery has been the topic of investigation. Historically, radical resections have been performed but they result in high rates of post-operative morbidity. Newer studies have compared radical resection with wide local excisions and found comparable outcomes. Anorectal melanoma is frequently a systemic disease. The ideal systemic therapy regimen has not yet been determined but numerous studies show a benefit to multi-agent treatments. Radiation therapy is typically given in the post-operative or palliative setting. CONCLUSIONS Anorectal mucosal melanoma is a very rare but aggressive disease with a poor prognosis. The overall treatment goal should strive to optimize quality of life and tumor control while minimizing treatment-related morbidities.
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Affiliation(s)
- Ted C Ling
- Departments of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Jason M Slater
- Departments of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Maheswari Senthil
- Surgical Oncology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Kevork Kazanjian
- Surgical Oncology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Frank Howard
- Medical Oncology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Carlos A Garberoglio
- Surgical Oncology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Jerry D Slater
- Departments of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Gary Y Yang
- Departments of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
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Efficacy and safety of ipilimumab 3mg/kg in patients with pretreated, metastatic, mucosal melanoma. Eur J Cancer 2014; 50:121-7. [DOI: 10.1016/j.ejca.2013.09.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/04/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022]
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Lerondeau B, Granel-Brocard F, Cuny JF, Specty-Ferry J, Bressler L, Barbaud A, Schmutz JL. [Melanoma of the anal margin]. Ann Dermatol Venereol 2013; 140:444-7. [PMID: 23773742 DOI: 10.1016/j.annder.2013.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/14/2013] [Accepted: 02/14/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Primary anal mucosal melanoma is rare and is associated with a poor prognosis. The observation of a case of anal melanoma at a localized stage in a woman led us to analyze recent data from the literature on therapeutic alternatives. PATIENTS AND METHODS A 49-year-old woman presented with a pigmented swelling of the anal margin that had begun three months earlier. Complete local excision of the tumour was performed with the conservation of the anal sphincters. Histological examination revealed SSM mucosal melanoma. Abdominoperineal resection was finally performed because of tumoural invasion of the lateral margins. Staging assessment was normal. Half-yearly MRI monitoring of the pelvis was proposed and at nine months no relapse was seen. DISCUSSION The unusual and misleading symptoms often account for the late diagnosis and poor prognosis of anal melanoma. Treatment is not well defined: local excision with conservation of the anal sphincters is recommended as first-line therapy, but the surgical technique is controversial. Abdominoperineal resection is recommended if the surgical margins are invaded, in the case of local recurrence or if the tumour is inaccessible. The place of adjuvant therapies remains to be defined. More recently, the discovery of mutation in c-KIT mucosal melanoma has allowed the use of biotherapy. Our observation underscores the importance of early detection of anal melanoma by all practitioners concerned in view of its aggressiveness and we report the difficulties of therapeutic management in the absence of established guidelines.
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Affiliation(s)
- B Lerondeau
- Service de dermatologie, hôpitaux de Brabois, CHU de Nancy, bâtiment des spécialités médicales Philippe-Canton, rue du Morvan, 54500 Vandœuvre-Les-Nancy, France.
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37
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Postow MA, Luke JJ, Bluth MJ, Ramaiya N, Panageas KS, Lawrence DP, Ibrahim N, Flaherty KT, Sullivan RJ, Ott PA, Callahan MK, Harding JJ, D'Angelo SP, Dickson MA, Schwartz GK, Chapman PB, Gnjatic S, Wolchok JD, Hodi FS, Carvajal RD. Ipilimumab for patients with advanced mucosal melanoma. Oncologist 2013; 18:726-32. [PMID: 23716015 DOI: 10.1634/theoncologist.2012-0464] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The outcome of patients with mucosal melanoma treated with ipilimumab is not defined. To assess the efficacy and safety of ipilimumab in this melanoma subset, we performed a multicenter, retrospective analysis of 33 patients with unresectable or metastatic mucosal melanoma treated with ipilimumab. The clinical characteristics, treatments, toxicities, radiographic assessment of disease burden by central radiology review at each site, and mutational profiles of the patients' tumors were recorded. Available peripheral blood samples were used to assess humoral immunity against a panel of cancer-testis antigens and other antigens. By the immune-related response criteria of the 30 patients who underwent radiographic assessment after ipilimumab at approximately week 12, there were 1 immune-related complete response, 1 immune-related partial response, 6 immune-related stable disease, and 22 immune-related progressive disease. By the modified World Health Organization criteria, there were 1 immune-related complete response, 1 immune-related partial response, 5 immune-related stable disease, and 23 immune-related progressive disease. Immune-related adverse events (as graded by Common Terminology Criteria for Adverse Events version 4.0) consisted of six patients with rash (four grade 1, two grade 2), three patients with diarrhea (one grade 1, two grade 3), one patient with grade 1 thyroiditis, one patient with grade 3 hepatitis, and 1 patient with grade 2 hypophysitis. The median overall survival from the time of the first dose of ipilimumab was 6.4 months (range: 1.8-26.7 months). Several patients demonstrated serologic responses to cancer-testis antigens and other antigens. Durable responses to ipilimumab were observed, but the overall response rate was low. Additional investigation is necessary to clarify the role of ipilimumab in patients with mucosal melanoma.
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Affiliation(s)
- Michael A Postow
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Tapan U, Dizdar O, Bulut N, Celik I. Multimodality treatment in the management of anorectal melanoma: a case report and review of the literature. Eurasian J Med 2011; 43:189-91. [PMID: 25610191 DOI: 10.5152/eajm.2011.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/17/2011] [Indexed: 11/22/2022] Open
Abstract
Anorectal melanoma represents approximately 0.2-1% of all malignant melanomas and has a poor prognosis, with a median survival of 8 to 23 months after the time of diagnosis. The typical treatment modalities include surgery, radiotherapy and chemotherapy. The particular approach taken depends on the patient's status and disease stage. Although there are different treatment options for this rare condition, there are not enough studies on multimodality treatment. Here, we present the case of a 54-year-old female with anorectal melanoma that had metastasized to an inguinal lymph node. She underwent local excision of the rectal mass and inguinal lymph-node dissection. Temozolomide treatment was started after radiotherapy and was given for 24 months. Follow-up revealed that the patient has been doing well with no signs of recurrence three years after the completion of treatment. We aim to discuss combined treatment modalities for ARM in light of the pertinent literature.
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Affiliation(s)
- Umit Tapan
- Department of Internal Medicine, Faculty of Medicine, Carney Hospital, Tufts University, Boston, USA
| | - Omer Dizdar
- Department of Medical Oncology, Institute of Oncology, Hacettepe University Ankara, Turkey
| | - Nilufer Bulut
- Department of Medical Oncology, Institute of Oncology, Hacettepe University Ankara, Turkey
| | - Ismail Celik
- Department of Medical Oncology, Institute of Oncology, Hacettepe University Ankara, Turkey
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40
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Díaz-Sánchez A, Lara MÁ, Ortega P, Aramendi T, González C, Alberdi JM, Del Valle E, Casado I, Campos R, Aldeguer M. [Colorectal melanoma: review of two distinct forms of presentation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:83-8. [PMID: 21333392 DOI: 10.1016/j.gastrohep.2010.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 10/25/2010] [Accepted: 10/29/2010] [Indexed: 11/28/2022]
Abstract
Malignant melanoma of the colon and rectum is an infrequent disease. Primary anorectal melanoma accounts for 0.1-4.6% of all malignant neoplasms of the anal canal. Melanoma metastatic to the colon is symptomatic only in 4.4% of patients with a primary melanoma at another site and most of these tumors are diagnosed postmortem. We report two cases of colorrectal malignant melanoma. The first case concerned a patient with rectal bleeding who was diagnosed with a rectal lesion compatible with melanoma. Abdominoperineal resection was performed due to positivity of the sentinel lymph node. We discuss the utility of sentinel lymph node detection in this kind of tumor. In the second case, we discovered a polyp compatible with metastatic melanoma in the transverse colon in a patient with a previous diagnosis of melanoma. In both surgical specimens, the diagnosis of melanoma was confirmed by positivity for protein S-100, Melan-A and HMB-45.
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Affiliation(s)
- Antonio Díaz-Sánchez
- Sección de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España.
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Che X, Zhao DB, Wu YK, Wang CF, Cai JQ, Shao YF, Zhao P. Anorectal malignant melanomas: Retrospective experience with surgical management. World J Gastroenterol 2011; 17:534-9. [PMID: 21274385 PMCID: PMC3027022 DOI: 10.3748/wjg.v17.i4.534] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 07/20/2010] [Accepted: 07/27/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences.
METHODS: Medical records of the diagnosis, surgery, and follow-up of 56 patients with anorectal melanoma who underwent surgery between 1975 and 2008 were retrospectively reviewed. The factors predictive for the survival rate of these patients were identified using multivariate analysis.
RESULTS: The 5-year survival rate of the 56 patients with anorectal melanoma was 20%, 36 patients underwent abdominoperineal resection (APR) and 20 patients underwent wide local excision (WLE). The rates of local recurrence of the APR and WLE groups were 16.13% (5/36) and 68.75% (13/20), (P = 0.001), and the median survival time was 22 mo and 21 mo, respectively (P = 0.481). Univariate survival analysis demonstrated that the number of tumor and the depth of invasion had significant effects on the survival (P < 0.05). Multivariate analysis showed that the number of tumor [P = 0.017, 95% confidence interval (CI) = 1.273-11.075] and the depth of invasion (P = 0.015, 95% CI = 1.249-7.591) were independent prognostic factors influencing the survival rate.
CONCLUSION: Complete or R0 resection is the first choice of treatment for anorectal melanoma, prognosis is poor regardless of surgical approach, and early diagnosis is the key to improved survival rate for patients with anorectal melanoma.
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Abdominoperineal resection or local excision? a survival analysis of anorectal malignant melanoma with surgical management. Melanoma Res 2010; 20:338-41. [PMID: 20414138 DOI: 10.1097/cmr.0b013e328339b159] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patients with anorectal malignant melanoma (AMM) generally have an unfavorable prognosis, and surgical managements are still in controversy. The purpose of this study was to evaluate the surgical treatment for AMM in China and to compare the survival of abdominoperineal resection (APR) and local excision (LE) in patients with AMM. Between 1995 and 2007, 54 patients managed with curative surgical resection for AMM were reviewed, 39 patients underwent APR, and 15 patients underwent LE. Life table was carried out and Kaplan-Meier test was used to compare the effects of these two different surgical procedures in survival. The overall 1-year, 2-year, 3-year, and 5-year survival rates after curative operation were 80, 54, 43, and 26%, respectively; LE group were 67, 48, 48, and 16%, and APR group were 84, 57, 42, and 30%, respectively. The median survival for all LE and APR were 25 months, 13 months, and 25 months, respectively. Kaplan-Meier test showed that there was no significant difference between APR and LE in survival (P=0.281); however, a 5-year survival advantage for the patients who underwent APR was found, despite the severity of tumor. Local recurrence after LE was more popular than APR (P=0.020). The prognosis of AMM after curative surgery is poor now, and patients undergoing APR have no significant survival advantage than those underwent LE. Local recurrence after LE was more popular than APR.
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43
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Anorectal malignant melanoma: Diagnosis and treatment of 42 cases. Chin J Cancer Res 2010. [DOI: 10.1007/s11670-010-0176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Anal melanoma is rare and aggressive malignancy. Patients commonly present with advanced, even metastatic disease. Unlike cutaneous melanoma, anal melanoma has no known risk factors. Surgical excision remains the cornerstone of therapy. There are no long-term survivors of stage II or III disease; therefore, early diagnosis and treatment remain crucial. There are no trials definitively proving abdominal perineal resection (APR) or wide local excision (WLE) to yield superior long-term survival. APR may offer a higher rate of local control, whereas WLE offers a much less morbid operation. Adjuvant chemotherapy, interferon, and radiation may offer some benefit.
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Affiliation(s)
- Marc Singer
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
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45
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Kiran RP, Rottoli M, Pokala N, Fazio VW. Long-term outcomes after local excision and radical surgery for anal melanoma: data from a population database. Dis Colon Rectum 2010; 53:402-8. [PMID: 20305438 DOI: 10.1007/dcr.0b013e3181b71228] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Anal melanoma is rare and associated with a poor outcome. Previous studies that have reported outcomes after surgical treatment are limited by both small number of participants and treatment at single centers only. This study evaluates survival of patients undergoing surgery for anal melanoma from a prospective, population-based database. METHODS Characteristics and survival of patients undergoing rectal resection or local excision for anal melanoma of the anus, anal canal, and overlapping region of the rectum from 1982 to 2002 were obtained from the Surveillance, Epidemiology and End Results database and compared. RESULTS A total of 160 patients were included in the study. Details of previous surgical procedures were available for 109 of the study patients: 60 (55%) underwent local excision and 49 (45%) rectal resection. Patients who underwent local excision were significantly older (73.5 vs 65.1 years, P < .001), whereas those who had undergone rectal resection had a greater proportion of regional disease (73.5% vs 16.7%, P < .001). The median survival of the 2 groups was similar (rectal resection vs local excision: 17 vs 28 months, P = .3). Rectal resection and local excision were associated with similar survival for patients in both regional (P = .6) and localized (P = .95) stages. Outcomes for patients who were appropriately pathologically staged after rectal resection depended on localized vs regional stage (5-year survival: 43.1% vs 12.5%, P = .17). Survival for patients in localized and regional stages who underwent rectal resection was similar to that for patients with corresponding clinical stage who underwent local excision. CONCLUSION Survival of patients with anal melanoma is similar after local excision or rectal resection irrespective of whether patients have localized or regional stage of disease.
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Affiliation(s)
- Ravi P Kiran
- Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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46
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Ellis ZM, Jassim AD, Wick MR. Anorectal melanoma in childhood and adolescence. Ann Diagn Pathol 2010; 14:69-73. [DOI: 10.1016/j.anndiagpath.2009.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/13/2009] [Accepted: 07/16/2009] [Indexed: 12/28/2022]
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Effect of misdiagnosis on the prognosis of anorectal malignant melanoma. J Cancer Res Clin Oncol 2010; 136:1401-5. [PMID: 20130908 DOI: 10.1007/s00432-010-0793-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 01/14/2010] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Anorectal malignant melanoma (AMM) is frequently subjected to misdiagnosis. Here the effect of misdiagnosis on the prognosis of AMM was investigated. METHODS Between 1995 and 2007, 79 patients managed for AMM were reviewed; 46 (58.23%) of them had been misdiagnosed during the symptoms, while 33 (41.77%) cases had been diagnosed exactly not more than 1 week after the first visit. Diseases misdiagnosed were categorized as cancer, hemorrhoids, polyps and other diseases. Data were statistically analyzed by using the life tables and Kaplan-Meier curves. The software used was SPSS 16.0 for Windows. RESULTS The 1-, 2-, 3- and 5-year survival rates of AMM patients were 58, 33, 24 and 16%, respectively, and the median survival time was 14.0 months; 1-, 2-, 3- and 5-year survival rates of the misdiagnosed patients were 61, 22, 22 and 11%, respectively, and the median survival time was 14.0 months; 1-, 2-, 3- and 5-year survival rates of the patients not misdiagnosed were 55, 44, 25 and 25%, respectively, and the median survival time was 12.0 months. Analyses based on Kaplan-Meier curves revealed no significant effect of misdiagnosis on the survival of AMM patients (P > 0.05). Nevertheless, the diseases misdiagnosed significantly affect the prognosis (P = 0.009); AMM misdiagnosed as hemorrhoids had a poor prognosis, with a 1-year survival rate of only 29% and the median survival of only 6.0 months. CONCLUSIONS The misdiagnosed patients had relatively poor prognosis, but the effect of misdiagnosis on the prognosis was not significant; however, misdiagnosis of AMM as hemorrhoids seriously affected the prognosis.
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Stoidis CN, Spyropoulos BG, Misiakos EP, Fountzilas CK, Paraskeva PP, Fotiadis CI. Diffuse anorectal melanoma; review of the current diagnostic and treatment aspects based on a case report. World J Surg Oncol 2009; 7:64. [PMID: 19671138 PMCID: PMC2731760 DOI: 10.1186/1477-7819-7-64] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 08/11/2009] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Christos N Stoidis
- 3rd Department of Surgery, University of Athens Medical School, Attikon University Hospital, Athens, Greece.
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49
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Complete response of stage IV anal mucosal melanoma expressing KIT Val560Asp to the multikinase inhibitor sorafenib. NATURE CLINICAL PRACTICE. ONCOLOGY 2008; 5:737-40. [PMID: 18936790 DOI: 10.1038/ncponc1251] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 07/18/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND A 79-year-old man presented to his primary care physician with a 2-month history of pruritus ani and a pigmented nodular lesion was discovered in the posterior rectum. The patient had no other symptoms, or any family history of malignancy. INVESTIGATIONS Physical examination; excisional biopsy; CT scan of the chest, abdomen and pelvis; lung biopsy; blood tests; tumor immunohistochemistry for KIT, vascular endothelial growth factor platelet-derived growth factor receptor alpha and beta, and mismatch-repair proteins MLH1, MSH2, and MSH6; and KIT and BRAF tumor genotyping. DIAGNOSIS Stage IV M1b metastatic anal mucosal melanoma. MANAGEMENT Wide local excision with mucosal advancement of the rectal wall, external-beam radiation, and sorafenib-temozolomide therapy.
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van't Riet M, Giard RWM, de Wilt JHW, Vles W. Melanoma of the anus disguised as hemorrhoids: surgical management illustrated by a case report. Dig Dis Sci 2007; 52:1745-7. [PMID: 17415639 PMCID: PMC1914244 DOI: 10.1007/s10620-006-9485-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 06/12/2006] [Indexed: 12/12/2022]
Affiliation(s)
- M van't Riet
- Department of Surgery, Ikazia Hospital, Postbus 5009, 3008, Rotterdam, The Netherlands.
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