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Lattanzi M, Lee Y, Simpson D, Moran U, Darvishian F, Kim RH, Hernando E, Polsky D, Hanniford D, Shapiro R, Berman R, Pavlick AC, Wilson MA, Kirchhoff T, Weber JS, Zhong J, Osman I. Primary Melanoma Histologic Subtype: Impact on Survival and Response to Therapy. J Natl Cancer Inst 2020; 111:180-188. [PMID: 29912415 PMCID: PMC7962783 DOI: 10.1093/jnci/djy086] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/28/2018] [Accepted: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Two primary histologic subtypes, superficial spreading melanoma (SSM) and nodular melanoma (NM), comprise the majority of all cutaneous melanomas. NM is associated with worse outcomes, which have been attributed to increased thickness at presentation, and it is widely expected that NM and SSM would exhibit similar behavior once metastasized. Herein, we tested the hypothesis that primary histologic subtype is an independent predictor of survival and may impact response to treatment in the metastatic setting. METHODS We examined the most recent Surveillance, Epidemiology, and End Results (SEER) cohort (n = 118 508) and the New York University (NYU) cohort (n = 1621) with available protocol-driven follow-up. Outcomes specified by primary histology were studied in both the primary and metastatic settings with respect to BRAF-targeted therapy and immunotherapy. We characterized known driver mutations and examined a 140-gene panel in a subset of NM and SSM cases using next-generation sequencing. All statistical tests were two-sided. RESULTS NM was an independent risk factor for death in both the SEER (hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.41 to 1.70, P < .001) and NYU (HR = 1.47, 95% CI = 1.05, 2.07, P = .03) cohorts, controlling for thickness, ulceration, stage, and other variables. In the metastatic setting, NM remained an independent risk factor for death upon treatment with BRAF-targeted therapy (HR = 3.33, 95% CI = 1.06 to 10.47, P = .04) but showed no statistically significant difference with immune checkpoint inhibition. NM was associated with a higher rate of NRAS mutation (P < .001), and high-throughput sequencing revealed NM-specific genomic alterations in NOTCH4, ANK3, and ZNF560, which were independently validated. CONCLUSIONS Our data reveal distinct clinical and biological differences between NM and SSM that support revisiting the prognostic and predictive impact of primary histology subtype in the management of cutaneous melanoma.
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Affiliation(s)
- Michael Lattanzi
- Department of Medicine.,Interdisciplinary Melanoma Cooperative Group
| | - Yesung Lee
- Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology
| | - Danny Simpson
- Interdisciplinary Melanoma Cooperative Group.,Department of Population Health
| | - Una Moran
- Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology
| | - Farbod Darvishian
- Interdisciplinary Melanoma Cooperative Group.,Department of Pathology
| | - Randie H Kim
- Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology
| | - Eva Hernando
- Interdisciplinary Melanoma Cooperative Group.,Department of Pathology
| | - David Polsky
- Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology.,Department of Pathology
| | - Doug Hanniford
- Interdisciplinary Melanoma Cooperative Group.,Department of Pathology
| | - Richard Shapiro
- Interdisciplinary Melanoma Cooperative Group.,Department of Surgery, NYU School of Medicine, New York, NY
| | - Russell Berman
- Interdisciplinary Melanoma Cooperative Group.,Department of Surgery, NYU School of Medicine, New York, NY
| | - Anna C Pavlick
- Department of Medicine.,Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology
| | - Melissa A Wilson
- Department of Medicine.,Interdisciplinary Melanoma Cooperative Group
| | - Tomas Kirchhoff
- Interdisciplinary Melanoma Cooperative Group.,Department of Population Health
| | - Jeffrey S Weber
- Department of Medicine.,Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology
| | - Judy Zhong
- Interdisciplinary Melanoma Cooperative Group.,Department of Population Health
| | - Iman Osman
- Department of Medicine.,Interdisciplinary Melanoma Cooperative Group.,The Ronald O. Perelman Department of Dermatology
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Treatment Strategies and Survival Trends for Anorectal Melanoma: Is it Time for a Change? World J Surg 2019; 43:1809-1819. [PMID: 30830243 DOI: 10.1007/s00268-019-04960-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM. METHODS Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed. RESULTS A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type. CONCLUSION The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.
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The treatment of perianal skin horseshoe melanoma by advancement flap (Y-V shaped) and the assessment of outcome over a long-term follow-up. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Anorectal malignant melanoma is a rare tumor with a poor prognosis. Typical symptoms (bleeding, pain, perianal mass) are characteristic of hemorrhoids. This, together with the high rate of amelanotic tumors, often delays diagnosis. No therapy guidelines exist. MATERIALS AND METHODS Based on our own experience of surgically treated patients and an extensive literature search, we present a stage-dependent therapeutic concept. RESULTS Eight patients (six women) with a mean age of 65 ± 8 years were treated at our institution. Six underwent abdominoperineal resection; two had local excision. Two patients additionally underwent inguinal lymph node dissection. Median survival was 12 months with a disease-free survival of 6 months. Forty treatment studies with a total of 1,970 cases could be identified. Prognostic factors are age, time to correct diagnosis, tumor extent, tumor stage, and perineural invasion. The impact of lymph node metastases and R0 resection varies. Surgery is the only effective therapy. Local excision is sufficient when free resection margins are achieved. CONCLUSIONS Locally limited tumors should be resected; if possible using local excision. Larger tumors or tumors with sphincter infiltration often require abdominoperineal resection with curative intent. When regional lymph node metastases are present, we advise regional lymphadenectomy of the affected area. In the case of distant metastases, palliative surgery is needed for metastasectomy and in cases of incontinence or refractory pain.
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Paolino G, Moliterni E, Corsetti P, Didona D, Bottoni U, Calvieri S, Mattozzi C. Vitamin D and melanoma: state of the art and possible therapeutic uses. GIORN ITAL DERMAT V 2017; 154:64-71. [PMID: 29249122 DOI: 10.23736/s0392-0488.17.05801-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Despite the presence of several studies in literature, the real connection between vitamin D serological levels, vitamin D receptor and melanoma remains unclear, probably because of the complex correlation between vitamin D and melanoma. Indeed, UV radiations are not reported as the main risk factor for melanoma in non-sun-exposed, while systemic immunosuppression, anatomical and physiological features may contribute to malignancy. Therefore, the correlation between melanoma cells in sun-exposed areas and vitamin D, as well as vitamin D receptor could be different from the one in melanoma of sun-shielded sites. These differences may also explain the controversial results reported in the literature regarding the correlation between melanoma and vitamin D, as well as the different outcomes in melanoma patients treated with vitamin D as adjuvant therapy. The aim of this review is to highlight the most recent findings about vitamin D and melanoma, focusing on the anatomic site of the primary tumor as well as on the possible therapeutic uses of vitamin D in melanoma patients.
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Affiliation(s)
| | | | | | - Dario Didona
- Division of Dermatology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Ugo Bottoni
- Department of Dermatology, Magna Grecia University, Catanzaro, Italy
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Abstract
BACKGROUND Anorectal melanoma is a rare type of malignant melanoma and thus the epidemiology of patients with this tumor has been poorly defined. OBJECTIVE To describe the epidemiology of anorectal melanoma in the United States. METHODS AND MATERIALS We obtained case and population data from the Surveillance, Epidemiology, and End Results 13 Registries Database (SEER 13) between 1992 and 2011 using rectal diagnostic codes C20.9 to 21.8 and ICD-O-3 melanoma codes 8720 to 8721 and 8742 to 8746. RESULTS There were 260 primary anorectal melanomas in SEER 13 from 1992 to 2011, occurring mostly in the rectum. The incidence of anorectal melanoma was higher among women than men with the highest rates occurring among white Hispanics ages 65 to 74 years. During this time period, the age-adjusted incidence rates rose significantly (p < .05) for both women and men with estimated annual percentage changes of 3.02% and 5.08%, respectively. Overall and melanoma-specific survival was poor irrespective of gender or ethnicity. CONCLUSION Anorectal melanoma in the United States is increasing in both men and women, with the highest rates in elderly Hispanic white women. Hispanic whites were more likely to develop anorectal melanoma than non-Hispanic whites, suggesting that this population may be targeted for screening interventions. These results warrant further investigation to better understand the gender, racial, ethnic, and geographic variations for anorectal melanomas.
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Tan J. Perianal melanoma with a BRAF gene mutation in a young Portuguese Roma native. BMJ Case Rep 2016; 2016:bcr-2015-212772. [PMID: 26880821 DOI: 10.1136/bcr-2015-212772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A case of a young man diagnosed with perianal nodular melanoma with a gene mutation, accompanied by regional and pulmonary metastases on initial presentation, and later on with hepatic and bone involvement, is presented. The patient underwent wide local excision but was unresponsive to dacarbazine. Targeted therapy with vemurafenib had shown clinical improvement for a 5-month duration until he showed signs of disease progression. Just after the shift of adjuvant therapy to ipilimumab, he was diagnosed with multiple cerebral metastases that eventually led to his demise 6 months after initiation of vemurafenib, having had a 12-month survival period from the time of initial melanoma diagnosis.
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Clinicopathological features, vitamin D serological levels and prognosis in cutaneous melanoma of shield-sites: an update. Med Oncol 2014; 32:451. [DOI: 10.1007/s12032-014-0451-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 12/27/2022]
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Juzeniene A, Grigalavicius M, Baturaite Z, Moan J. Minimal and maximal incidence rates of skin cancer in Caucasians estimated by use of sigmoidal UV dose-incidence curves. Int J Hyg Environ Health 2014; 217:839-44. [PMID: 25023193 DOI: 10.1016/j.ijheh.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sigmoidal (S-shaped) dose-cancer incidence relationships are often observed in animal bioassays for carcinogenicity. Ultraviolet (UV) radiation is an established skin carcinogen. The aim of this study is to examine if S-shaped curves describe the relationship between solar UV doses and skin cancer incidences, and if such relationships can be used to estimate threshold levels of non-carcinogenic UV exposure, as well as maximal incidence rates. METHODS We studied the incidence rate-annual erythema-effective UV dose relationship for squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and cutaneous melanoma (CM) among different Caucasian populations in Europe, Australia and New Zealand. RESULTS Our analysis indicates that S-shaped associations describe the data well (P < 0.0001). The age-adjusted incidence rates for cases expected to be due to other causes than solar UV exposure (at zero UV dose) were found to be around 0.6, 9.7 and 4.0 per 100,000 for women in 1997-2007 for SCC, BCC and CM, respectively, and around 1.2, 14.3 and 2.6 per 100,000 for men. The analysis indicates that SCC, BCC and CM have maximal incidence of 361 ± 24, 1544 ± 49 and 36 ± 4 per 100,000 for women, and 592 ± 35, 2204 ± 109 and 50 ± 4 per 100,000 for men. CONCLUSIONS Between 89 and 95% of the annual CM cases, around 99.8% SCC and 99.4% BCC cases are caused by solar UV exposure. The analysis did not identify any "safe" UV dose below which the risk for skin cancer was absent. Avoidance of UV radiation has a potential to reduce the incidence of skin cancer in fair-skinned population.
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Affiliation(s)
- Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, Montebello, 0310 Oslo, Norway.
| | - Mantas Grigalavicius
- Department of Radiation Biology, Institute for Cancer Research, Montebello, 0310 Oslo, Norway
| | - Zivile Baturaite
- Department of Radiation Biology, Institute for Cancer Research, Montebello, 0310 Oslo, Norway
| | - Johan Moan
- Department of Radiation Biology, Institute for Cancer Research, Montebello, 0310 Oslo, Norway; Department of Physics, University of Oslo, 0316 Oslo, Norway
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Moan J, Grigalavicius M, Baturaite Z, Dahlback A, Juzeniene A. The relationship between UV exposure and incidence of skin cancer. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 31:26-35. [DOI: 10.1111/phpp.12139] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Johan Moan
- Department of Radiation Biology; Institute for Cancer Research; The Norwegian Radium Hospital; Oslo University Hospital; Oslo Norway
- Department of Physics; University of Oslo; Oslo Norway
| | - Mantas Grigalavicius
- Department of Radiation Biology; Institute for Cancer Research; The Norwegian Radium Hospital; Oslo University Hospital; Oslo Norway
| | - Zivile Baturaite
- Department of Radiation Biology; Institute for Cancer Research; The Norwegian Radium Hospital; Oslo University Hospital; Oslo Norway
| | - Arne Dahlback
- Department of Physics; University of Oslo; Oslo Norway
| | - Asta Juzeniene
- Department of Radiation Biology; Institute for Cancer Research; The Norwegian Radium Hospital; Oslo University Hospital; Oslo Norway
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Bishop KD, Olszewski AJ. Epidemiology and survival outcomes of ocular and mucosal melanomas: a population-based analysis. Int J Cancer 2014; 134:2961-71. [PMID: 24272143 DOI: 10.1002/ijc.28625] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/13/2013] [Indexed: 01/15/2023]
Abstract
Extracutaneous melanomas are poorly characterized tumors that include ocular (OM), mucosal (MM) and leptomeningeal melanomas, often lacking standardized staging and treatment guidelines. We analyzed cases of cutaneous melanoma (CM, N = 219,890), OM (N = 7,069) and MM (N = 2,755) of different anatomical origins, diagnosed between 1988 and 2010, recorded in the Surveillance Epidemiology and End Results (SEER) database. Relative survival was studied in patients grouped by summary stage classification (localized, regional or distant disease) and in multivariate models adjusting for varying distribution of baseline factors. Unlike in CM, the incidence rate in MM increased exponentially with age. Five-year relative survival was significantly worse for OM (78%) and for most mucosal sites (aggregate 34%, range 3-69%) compared with CM (89%). The differences between primary sites were particularly pronounced in localized disease, with a hazard ratio of 5.7 for OM, 4.3-9.0 for external genital or oral cavity MM and 19.8-90.4 for other mucosal locations. Melanomas of the pharynx, gastrointestinal, urinary tract and vagina had poor outcomes regardless of clinical stage. In contrast to CM, there was no evidence of improved survival in OM and MM during the study period. A substantial proportion of patients with operable OM or MM underwent radical organ resections (13-88% depending on site and stage) or perioperative radiotherapy (0-66%). In conclusion, extracutaneous melanomas have a markedly worse survival than CM and aggressive locoregional management appears to be insufficient for their control. Because of poor outcomes in MM, studies of systemic therapy are warranted regardless of the extent of disease at presentation.
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Affiliation(s)
- Kenneth D Bishop
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI; Division of Hematology/Oncology, Rhode Island Hospital, Providence, RI
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Serrano MA, Cañada J, Moreno JC. Solar UV exposure in construction workers in Valencia, Spain. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:525-530. [PMID: 22739681 DOI: 10.1038/jes.2012.58] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/29/2012] [Indexed: 06/01/2023]
Abstract
Exposure to ultraviolet radiation (UVR) has long been recognized as the most important environmental risk factor for melanoma and skin cancer. Outdoor workers are among the groups most at risk from exposure to solar UVR in their daily activities. Sensitive spore-film filter-type personal dosimeters (VioSpor) were used to measure the biologically effective UVR received by construction workers in the course of their daily work. The study took place in Valencia, Spain, in July 2010 and involved a group of eight workers for a period of 5 days. The median UV exposure was 6.11 standard erythema dose (SED) per day, with 1 SED defined as effective 100 J/m(2) when weighted with the Commission Internationale de L'Eeclairage erythemal response function. These workers were found to receive a median of 13.9% of total daily ambient ultraviolet erythemal radiation (UVER). Comparison with the occupational UVR exposure limit showed that the subjects had received UVER exposure in excess of occupational guidelines, indicating that protective measures against this risk are highly advisable.
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Affiliation(s)
- María-Antonia Serrano
- Instituto de Ingeniería Energética, Universitat Politècnica de València, 46022 Valencia, España.
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Cazenave H, Maubec E, Mohamdi H, Grange F, Bressac-de Paillerets B, Demenais F, Avril M. Genital and anorectal mucosal melanoma is associated with cutaneous melanoma in patients and in families. Br J Dermatol 2013; 169:594-9. [DOI: 10.1111/bjd.12421] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 01/09/2023]
Affiliation(s)
- H. Cazenave
- Service de Dermatologie; APHP; Hôpital Bichat; Paris; France
| | | | | | - F. Grange
- Service de Dermatologie; Centre Hospitalier Universitaire Robert Debré; Reims; France
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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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