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Kozan R, Akpinar O, Toker M. Anorectal Malignant Melanoma Post- Hemorrhoidectomy. ACTA MEDICA PORT 2024; 37:556-559. [PMID: 38785172 DOI: 10.20344/amp.21262] [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] [Received: 01/24/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
Anorectal malignant melanoma, a rare and aggressive tumor, lacks specific symptoms and frequently presents diagnostic challenges due to its similarity to benign anorectal conditions. This case report describes the diagnostic and treatment process of incidentally discovered anorectal malignant melanoma post-hemorrhoidectomy, guided by the existing literature.
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Affiliation(s)
- Ramazan Kozan
- Department of General Surgery. Gazi University Faculty of Medicine. Ankara. Turkey
| | - Ozkan Akpinar
- Department of General Surgery. Gazi University Faculty of Medicine. Ankara. Turkey
| | - Meral Toker
- Department of Pathology. Gazi University Faculty of Medicine. Ankara. Turkey
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Temperley HC, O’Sullivan NJ, Keyes A, Kavanagh DO, Larkin JO, Mehigan BJ, McCormick PH, Kelly ME. Optimal surgical management strategy for treatment of primary anorectal malignant melanoma—a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:3193-3200. [DOI: 10.1007/s00423-022-02715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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Chiu HT, Pu TW, Yen H, Liu T, Wen CC. Is repeat wide excision plus radiotherapy of localized rectal melanoma another choice before abdominoperineal resection? A case report. World J Clin Cases 2022; 10:5057-5063. [PMID: 35801054 PMCID: PMC9198861 DOI: 10.12998/wjcc.v10.i15.5057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/03/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases. Abdominoperineal resection was regarded as the radical procedure for disease control. Nevertheless, it led to more postoperative complications than sphincter-sparing wide local excision (WLE) and reduced the patient’s quality of life (QOL) owing to creation of colostomy. Therefore, in this study, WLE, radiotherapy (RT), and a second WLE were conducted on a patient who had been diagnosed with localized rectal melanoma.
CASE SUMMARY The patient was a 79-year-old woman who had been experiencing anal pain and bloody stool for 1 mo. Colonoscopy, magnetic resonance imaging, positron emission tomography–computed tomography, and histological analysis of tissue biopsy using the histological markers Melan-A (+), S-100 (+), and Ki-67 (+, 50%) lead to the diagnosis of localized rectal melanoma. The patient had initially undergone WLE to resolve problem of anal bleeding, followed by RT to treat the residual lesion with partial response. Subsequently, the residual lesion was removed with margin-free resection by the second WLE. The patient’s postoperative course was smooth and uneventful. During the 2-year follow-up, no local recurrence was observed. Additionally, a good functional outcome and improved QOL were reported.
CONCLUSION Combining WLE, RT, and repeat WLE is proposed as a viable alternative for treating rectal melanoma accompanied by bleeding symptoms that cannot be completely resected at the beginning.
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Affiliation(s)
- Hao-Tse Chiu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 10581, Taiwan
| | - Hao Yen
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Tung Liu
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chia-Cheng Wen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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Jutten E, Kruijff S, Francken AB, Lutke Holzik MF, van Leeuwen BL, van Westreenen HL, Wevers KP. Surgical treatment of anorectal melanoma: a systematic review and meta-analysis. BJS Open 2021; 5:6446962. [PMID: 34958352 PMCID: PMC8675246 DOI: 10.1093/bjsopen/zrab107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Anorectal melanoma is a rare neoplasm with a poor prognosis. The surgical approaches for anorectal melanoma can be categorized into local excision (procedures without lymph node removal and preservation of the rectum) and extensive resection (procedures with rectum and pararectal lymph node removal). The aim of this systematic review and meta-analysis was to compare the survival of patients who underwent extensive resection with that of patients who underwent local excision, stratifying patients according to tumour stage. Methods A literature review was performed according to PRISMA guidelines by searching MEDLINE/PubMed for manuscripts published until March 2021. Studies comparing survival outcomes in patients with anorectal melanoma who underwent local excision versus extensive resection were screened for eligibility. Meta-analysis was performed for overall survival after the different surgical approaches, stratified by tumour stage. Results There were 347 studiesidentified of which 34 were included for meta-analysis with a total of 1858 patients. There was no significant difference in overall survival between the surgical approaches in patients per stage (stage I odds ratio 1.30 (95 per cent c.i. 0.62 to 2.72, P = 0.49); stage II odds ratio 1.61 (95 per cent c.i. 0.62 to 4.18, P = 0.33); stage I–III odds ratio 1.19 (95 per cent c.i. 0.83 to 1.70, P = 0.35). Subgroup analyses were conducted for the time intervals (<2000, 2001–2010 and 2011–2021) and for continent of study origin. Subgroup analysis for time interval and continent of origin also showed no statistically significant differences in overall survival. Conclusion No significant survival benefit exists for patients with anorectal melanoma treated with local excision or extensive resection, independent of tumour stage.
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Affiliation(s)
- Esther Jutten
- Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands.,Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Anne Brecht Francken
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - Martijn F Lutke Holzik
- Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Henderik L van Westreenen
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.,Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - Kevin P Wevers
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
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Kottakota V, Warikoo V, Yadav AK, Salunke A, Jain A, Sharma M, Bhatt S, Puj K, Pandya S. Clinical and oncological outcomes of surgery in Anorectal melanoma in Asian population: A 15 year analysis at a tertiary cancer institute. Cancer Treat Res Commun 2021; 28:100415. [PMID: 34119764 DOI: 10.1016/j.ctarc.2021.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Anorectal malignant melanoma (ARMM) is an aggressive malignancy with dismal prognosis and a 5-year survival rate less than 20% in most of the previous studies. The ideal surgical treatment has still remained controversial. This retrospective study aims at analysing the outcome in patients with ARMM treated with curative surgical resection. PATIENTS AND METHODS This is a retrospective study of 38 patients of stage I anorectal malignant melanoma treated with curative surgical resection at our tertiary cancer institute. RESULTS WLE (Wide Local Excision) was carried out in 12 patients and APR (abdominoperineal resection) was done in 26 patients. The median overall survival of the entire group in this study was 20 months. Although the median overall survival of WLE patients was higher than those with APR (37 months versus 16 months, respectively), this was not a statistically significant event (P=0.317). The 1-, 2-, 3-, 5-year survival rates were similar with both APR and WLE with no significant difference in the 5-year survival rate (P=0.816); overall 5-year survival rate of just 13%. There were 3 long-term survivors in this study group who survived for more than 10 years. CONCLUSION Most patients ultimately succumb to the disease regardless of the management. Both APR and WLE have significant roles in the management depending on the subset of patients selected. Local treatment should be preferred wherever possible. Abdominoperineal resection should be offered in nodal disease or in a recurrent setting.
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Affiliation(s)
- Viswanth Kottakota
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India.
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Ajay Kumar Yadav
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Abhijeet Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Abhishek Jain
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Mohit Sharma
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Supreet Bhatt
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Ketul Puj
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
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Jutten E, Kruijff S, Francken AB, van Westreenen HL, Wevers KP. Survival following surgical treatment for anorectal melanoma seems similar for local excision and extensive resection regardless of nodal involvement. Surg Oncol 2021; 37:101558. [PMID: 33839445 DOI: 10.1016/j.suronc.2021.101558] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anorectal melanoma is a rare malignancy with a dismal prognosis. The purpose of this study was to investigate whether the survival per stage is influenced by the surgical approaches (local excision or extensive resection), to assess prognostic factors of survival, and to answer the question whether the practiced surgical approaches changed over time. METHODS Dutch cancer registry organizations (IKNL and PALGA) were queried for all patients with a diagnosis of anorectal melanoma (1989-2019). Patients with disseminated disease at diagnosis were excluded. Survival outcomes were compared for the two surgical approaches stratified by stage (clinical node negative (cN0) and clinical node positive (cN+)) and date of diagnosis. RESULTS A total of 103 patients were included in this study. In both cN0 and cN+ patients the surgical strategy did not significantly influence survival (cN0: 21.7% 5-year survival, median 25 months for local excision versus 13.7% 5-year survival, median 17 months for extensive resection (p = 0.228), cN+: 11.1% 5-year survival for local excision, median 17 months versus 8.7% 5-year survival, median 14 months for extensive resection (p = 0.741)). Stage and date of diagnosis showed to be prognostic factors of survival. The ratio between the two surgical approaches was unchanged over three decades. CONCLUSIONS Extensive resection does not seem to improve survival in both cN0 and cN+ anorectal melanoma patients compared to local excision. However in the past three decades no shift towards local excision has been found. cN+ stage and an older date of diagnosis are predictors for worse survival.
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Affiliation(s)
- E Jutten
- Isala Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - S Kruijff
- University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - A B Francken
- Isala Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | | | - K P Wevers
- Isala Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
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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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