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Emile SH, Horesh N, Garoufalia Z, Gefen R, Dourado J, Wexner SD. A national database analysis of the evolution of outcomes of surgery for anal melanoma. J Surg Oncol 2024; 129:1213-1223. [PMID: 38533993 DOI: 10.1002/jso.27631] [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: 02/21/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND This study assessed trends in treatment and outcomes of anal melanomas over a 17-year period. METHODS NCDB was searched for patients with anal melanoma (2004-2020). Receiver-operating characteristic curve analysis was used to determine cutoff year marking increased overall survival (OS) of anal melanoma. Characteristics, treatments, and outcomes in consecutive time periods were compared. RESULTS A total of 815 patients (mean age: 67.2 years; 59.4% female) were included: 354 in Period 1 (2004-2012) and 461 in Period 2 (2013-2020). Period 2 included fewer abdominoperineal resections (18% vs. 28%, p = 0.002), more local tumor excisions (61.1% vs. 55%, p = 0.002), more often immunotherapy (odds ratio [OR]: 3.41, 95% confidence interval [CI]: 2.22-5.22, p < 0.001) and less often chemotherapy (OR: 0.516, 95% CI: 0.352-0.755, p < 0.001) administered and longer median OS (25.2 vs. 19.8 months, p = 0.006). Independent predictors of worse OS were older age (hazard ratio [HR]: 1.02, p = 0.012), higher Charlson score (HR: 2.32, p = 0.02), and greater number of positive lymph nodes (HR: 1.15, p < 0.001); conversely private insurance (HR: 0.385, p = 0.008) was predictive of increased OS. CONCLUSIONS Anal melanoma patients diagnosed between 2013 and 2020 underwent fewer abdominoperineal resections and more local excisions than patients diagnosed between 2004 and 2013. Increased immunotherapy and longer median OS were noted in period two. Age and private insurance were significant predictors of OS, remaining constant across time periods.
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Affiliation(s)
- Sameh H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery and transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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2
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Trabelsi MM, Kammoun N, Inoubli M, Chaouch MA, Ben Romdhane H, Koubaa W, Jerraya H. Organ preservation in anorectal melanoma: A tempting challenge-a case report. SAGE Open Med Case Rep 2023; 11:2050313X231208529. [PMID: 37886628 PMCID: PMC10599109 DOI: 10.1177/2050313x231208529] [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: 08/23/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
Melanoma arising from melanocytes is an uncommon neoplastic lesion, with rare occurrences in anorectal mucosa. While mucosal melanomas constitute a small portion of all melanomas, anorectal cases are even rarer and present with aggressive behavior and poor prognosis. Surgical management is central, with evolving debates regarding optimal approaches. We present a case of a 60-year-old woman with anorectal melanoma. She complained of rectal bleeding and weight loss. Clinical examination and pelvic magnetic resonance imaging revealed a 3-cm budding lesion on the anterior rectal wall. Colonoscopy identified a pedunculated anorectal tumor of 3 cm, situated 4 cm from the anal margin. A biopsy led us to a malignant lesion: anorectal melanoma. Pelvic imaging displayed a localized tumor, prompting wide local excision with millimetric negative margins. These resection margins were estimated insufficient, even in front of R0 resection. Thus, and after multidisciplinary discussion, we opted for abdominoperineal resection after wide local excision. Lymph nodes were biopsied, confirming no residual tumor. Follow-up exhibited no recurrence at 1 year. Our case emphasizes the pivotal role of surgical strategy in managing anorectal melanoma, challenging the paradigm of organ preservation. Despite therapeutic progress, surgery remains integral, contributing to improved outcomes and addressing the metastatic potential inherent to this disease.
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Affiliation(s)
| | - Neirouz Kammoun
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Marwa Inoubli
- Department of Radiology, Salah-Azaiz Institute, Tunis, Tunisia
| | | | | | - Wafa Koubaa
- Laboratoire d’anatomopathologie, Centre Carrefour Médical, Tunis, Tunisia
| | - Hichem Jerraya
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
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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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Fastner S, Hieken TJ, McWilliams RR, Hyngstrom J. Anorectal melanoma. J Surg Oncol 2023; 128:635-644. [PMID: 37395165 DOI: 10.1002/jso.27381] [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: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
Anorectal melanoma is an aggressive mucosal melanoma subtype with a poor prognosis. Although recent advancements have been seen for cutaneous melanoma, the optimal treatment paradigm for management of anorectal melanoma is evolving. In this review, we highlight differences in the pathogenesis of mucosal versus cutaneous melanoma, new concepts of staging for mucosal melanoma, updates to surgical management of anorectal melanoma, and current data for adjuvant radiation and systemic therapy in this unique patient population.
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Affiliation(s)
| | - Tina J Hieken
- Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John Hyngstrom
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City, Utah, USA
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5
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Bourouail O, Njoumi N, Elmahdaouy Y, Fahssi M, Yaka M, Hejjouji A, Ali AA. Long recurrence-free survival of localized rectal melanoma after abdominoperineal resection in comparison to partial excision and highlighting the place of immunotherapy: A case report. JRSM Open 2023; 14:20542704221148059. [PMID: 36762266 PMCID: PMC9905026 DOI: 10.1177/20542704221148059] [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] [Indexed: 02/08/2023] Open
Abstract
Rectal malignant melanomas (RMM) are remarkably uncommon, the rectal location represents less than one percent of all rectal cancer. Because of its low global survival rate, the surgical strategy is a subject of controversy for attaining a r0 resection. the palliative treatment is also debateable, but recently; radiotherapy and immunotherapy became the preferred treatment and offer the best outcome. to ensure r0 resection, abdominoperineal resection (apr) is considered the main surgical option, but because of its morbidity and functional limitations, local excision techniques such as endoscopic mucosal resection (emr) combined with chemoradiotherapy are being increasingly performed to preserve the quality of life and reduce local recurrence rate. In this report, we evaluate the place that apr still keeps as surgical procedure in comparison to partial excision. we report a case of a 72 years old patient, who presented rectal syndrome with rectorrhagia for 2 months, the diagnosis of localized rectal melanoma was confirmed by endoscopy, magnetic resonance imaging, histological analysis tissue with immunohistochemistry. the procedure strategy was a surgical treatment with apr. After a long recurrence-free survival period, the patient develops local recurrence and immunotherapy-resistant metastasis.
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Affiliation(s)
- Othmane Bourouail
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
| | - Noureddine Njoumi
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
| | - Youssef Elmahdaouy
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
| | - Mohamed Fahssi
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
| | - Mbarek Yaka
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
| | - Abderrahmane Hejjouji
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
| | - Abdelmounaim Ait Ali
- Visceral surgery department II, Military Teaching Hospital Mohamed V, Rabat, Morocco
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Ogata D, Tsutsui K, Namikawa K, Moritani K, Nakama K, Jinnai S, Takahashi A, Tsukamoto S, Kanemitsu Y, Yamazaki N. Treatment outcomes and prognostic factors in 47 patients with primary anorectal malignant melanoma in the immune therapy era. J Cancer Res Clin Oncol 2023; 149:749-755. [PMID: 35113236 DOI: 10.1007/s00432-022-03933-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Primary anorectal melanoma (ARM) accounts for approximately 1.2% of all melanomas and 16.5% of all mucosal melanomas. ARM is associated with the shortest interval to disease progression and the highest rate of metastasis; however, optimal therapeutic strategies for ARM remain controversial. This study aimed to assess the ideal surgical intervention for ARM and to determine the effect of immune checkpoint inhibitors (ICI). METHODS We included 47 patients with ARM treated at the National Cancer Center Hospital in Japan from 2011 to 2020. We performed a survival analysis for each of these groups: (i) patients with ARM (n = 47); (ii) operable non-stage IV cases at initial presentation (n = 35); and (iii) stage IV cases (n = 32). RESULTS The 5-year overall survival (OS) was 53.6%, and the median OS was 78.7 months in patients with ARM. No statistically significant difference in 5-year OS was found between rectal and anal sites (50.9% vs. 56.7%). In the non-stage IV subgroup, the type of surgery (abdominoperineal resection or wide local excision) did not correlate with OS (HR 1.85; 95% CI 0.46-7.5; p = 0.39). In the stage IV subgroup, the 2-year OS of the ICI treatment group was 61.4%, whereas that of the dacarbazine regimen group was 0% (p = 0.048). CONCLUSION Our ARM prognosis was better than that of previous studies. Our findings suggest that the availability of ICI therapy may improve survival in patients with advanced ARM. However, further research is warranted to identify both the clinical and molecular predictors of response to improve patient selection.
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Affiliation(s)
- Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
| | - Keita Tsutsui
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
- Department of Dermatology, Fukuoka University, 8-19-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Kenta Nakama
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Shunichi Jinnai
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
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7
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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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8
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Liu C, Tang C, Zhang J, Zhu P. Extensive resection improves overall and disease-specific survival in localized anorectal melanoma: A SEER-based study. Front Surg 2022; 9:997169. [PMID: 36111221 PMCID: PMC9468230 DOI: 10.3389/fsurg.2022.997169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anorectal melanoma is a rare tumor with a dismal prognosis. The only promising treatment for anorectal melanoma is surgery, either extensive resection (ER) or local excision (LE). However, the optimal extent of resection is still controversial. The purpose of this study was to investigate whether the survival outcomes of anorectal melanoma at different stages are influenced by the surgical approaches (LE or ER) using the National Institute of Health's Surveillance, Epidemiology, and End Results Program (SEER) database. Methods The Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients treated for anorectal melanoma (2000–2018). Overall survival (OS) and disease-specific survival (DSS) outcomes were compared for the two surgical approaches (ER or LE) stratified by stage (localized, regional and distant). Results A total of 736 patients were included in the study. Details of previous surgical procedures were available for 548 of the study patients: 360 (65.7%) underwent LE, and 188 (34.3%) underwent ER. In localized cases, 199 underwent LE, and 48 underwent ER. The OS (median 45 vs. 29 months, 5-year rate 41.7% vs. 23.4%) and DSS (median 66 vs. 34 months, 5-year rate 51% vs. 30.7%) of patients undergoing ER were significantly better (p = 0.009 and 0.041, respectively) than those who received LE. Multivariate analysis showed that the type of surgery was an independent prognostic factor for both OS and DSS. Among the regional cases, 89 cases had LE, and 96 cases had ER. Patients with regional disease who underwent ER had no significant differences in OS (23 vs. 21 months; p = 0.866) or DSS (24 vs. 24 months; p = 0. 907) compared to patients who underwent LE. In distant cases, 72 cases had LE, and 44 cases had ER. Patients with metastatic disease who had ER also had similar OS (median 11 vs. 8 months; p = 0.36) and DSS (median 11 vs. 8 months; p = 0.593) to those who underwent LE. Conclusion Extensive resection can improve the long-term prognosis of localized anorectal melanoma compared to local excision, but the prognosis of the two surgical techniques is comparable in both regional patients and distant patients.
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Affiliation(s)
- Chang Liu
- Department of Gastrointestinal Anorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cuiping Tang
- Department of cancer center, The Second Affiliated Hospital of Chongqing Medical University, Chong, China
| | - Jianbo Zhang
- Department of Gastrointestinal Anorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Zhu
- Department of Gastrointestinal Anorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Peng Zhu
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9
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QUAD SHOT radiotherapy and doublet immunotherapy in the management of anal mucosal melanoma: A case series of efficacy and toxicity of a novel treatment approach and a review of the literature. Clin Colorectal Cancer 2022; 21:e179-e186. [DOI: 10.1016/j.clcc.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
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10
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Jutten E, Kruijff S, Francken AB, Lutke Holzik MF, van Leeuwen BL, van Westreenen HL, Wevers KP. OUP accepted manuscript. BJS Open 2022; 6:6526448. [PMID: 35143632 PMCID: PMC8830752 DOI: 10.1093/bjsopen/zrac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- E. Jutten
- Department of Surgery, Hospital group Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - S. Kruijff
- Correspondence to: S. Kruijff, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands (e-mail: )
| | - A. B. Francken
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - M. F. Lutke Holzik
- Department of Surgery, Hospital group Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
| | - B. L. van Leeuwen
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - H. L. van Westreenen
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - K. P. Wevers
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
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Kazi M, Chatterjee A, Saklani A. OUP accepted manuscript. BJS Open 2022; 6:6526451. [PMID: 35143627 PMCID: PMC8830747 DOI: 10.1093/bjsopen/zrac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mufaddal Kazi
- Department of Colorectal Surgical Oncology, Tata Memorial Centre,
Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra
400012, India
| | - Ambarish Chatterjee
- Department of Colorectal Surgical Oncology, Tata Memorial Centre,
Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra
400012, India
| | - Avanish Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre,
Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra
400012, India
- Correspondence to: Avanish Saklani MS, FRCS, Professor and Head
Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National
Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai 400012, Maharashtra, India (e-mail:
)
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