Abstract
Anorectal melanomas represent a group of mucosal melanomas with unknown etiology and poor prognosis. The lesions can be misdiagnosed as hemorrhoids during clinical examination. We reviewed the morphological and clinical features of 14 anorectal melanomas, and discuss the treatment modalities of this entity. Fourteen patients who were diagnosed with anorectal malignant melanoma between 1997 and 2004 were evaluated with regard to age, sex, size, morphology, lymph node or distant metastasis, treatment modality and survival. Eight patients were female and six were male, and their mean age was 58 years. The size of melanoma ranged from 3 cm to 8 cm. Pathological evaluation revealed epithelioid and spindle cell type tumor in seven and two patients, respectively, whereas, in the remaining seven patients, the tumor was composed of both types. Pigmentation was apparent in all tumors. There was lymph node metastasis in 11 patients and distant metastasis in all patients. Eleven patients underwent abdominoperineal resection and three were treated by local excision. Mean survival was 8.7 months. Prognosis of anorectal melanoma remains poor. Awareness of the diverse clinicopathological features of these lesions, both on the part of the clinicians and pathologists, is crucial for their early detection and proper treatment.
Keywords: anal tumor, malignant melanoma, rectal tumor
Full Text
The Full Text of this article is available as a PDF (539.3 KB).
References
- 1. van Schaik PM, Ernst MF, Meijer HA, et al. Melanoma of the rectum: a rare entity. World J Gastroenterol. 2008; 14: 1633–1635. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Ahmad M, Mamoon N, Khan AH. Anorectal melanoma in northern Pakistan. J Pak Med Assoc. 1992; 42: 155–157. [PubMed] [Google Scholar]
- 3. Sashiyama H, Takayama W, Miyazaki S, et al. The diagnostic value of endoscopic ultrasonography and magnetic resonance imaging for anorectal malignant melanoma: report of a case. Surg Today. 2003; 33: 209–213. [DOI] [PubMed] [Google Scholar]
- 4. Homsi J, Garrett C. Melanoma of the anal canal: a case series. Dis Colon Rectum. 2007; 50: 1004–1010. [DOI] [PubMed] [Google Scholar]
- 5. Ishizone S, Koide N, Karasawa F, et al. Surgical treatment for anorectal malignant melanoma: report of five cases and review of 79 Japanese cases. Int J Colorectal Dis. 2008; 23: 1257–1262. [DOI] [PubMed] [Google Scholar]
- 6. Ramakrishnan AS, Mahajan V, Kannan R. Optimizing local control in anorectal melanoma. Indian J Cancer. 2008; 45: 13–19. [DOI] [PubMed] [Google Scholar]
- 7. Belli F, Gallino GF, Lo Vullo S, et al. Melanoma the anorectal region the experience of the National Cancer Institute of Milano. Eur J Surg Oncol. 2008; 3: 1–6. [DOI] [PubMed] [Google Scholar]
- 8. Nakamura T, Ide H. Malignant melanoma of the alimentary tract. Gan to Kagaku Ryoho. 2003; 30: 619–625. [PubMed] [Google Scholar]
- 9. Vaillant F, Salmon RJ, Rousseau J, et al. Malignant melanoma of the anal canal. Gastroenterol Clin Biol. 1983; 7: 228–229. [PubMed] [Google Scholar]
- 10. DeMatos P, Tyler DS, Seigler HF. Malignant melanoma of the mucous membranes: a review of 119 cases. Ann Surg Oncol. 1998; 5: 733–742. [DOI] [PubMed] [Google Scholar]
- 11. Clemmensen OJ, Fenger C. Melanocytes in the anal canal epithelium. Histopathol. 1991; 18: 237–241. [DOI] [PubMed] [Google Scholar]
- 12. Hussein MR. Extracutaneous malignant melanomas. Cancer Invest. 2008; 26: 516–534. [DOI] [PubMed] [Google Scholar]
- 13. Chute DJ, Cousar JB, Mills SE. Anorectal malignant melanoma: morphologic and immunohistochemical features. Am J Clin Pathol. 2006; 126: 93–100. [DOI] [PubMed] [Google Scholar]
- 14. DeMatos P, Tyler DS, Seigler HF. Malignant melanoma of the mucous membranes: a review of 119 cases. Ann Surg Oncol. 1998; 5: 733–742. [DOI] [PubMed] [Google Scholar]
- 15. Piura B. Management of primary melanoma of the female urogenital tract. Lancet Oncol. 2008; 9: 973–981. [DOI] [PubMed] [Google Scholar]
- 16. Patrick RJ, Fenske NA, Messina JL. Primary mucosal melanoma. J Am Acad Dermatol. 2007; 56: 828–834. [DOI] [PubMed] [Google Scholar]
- 17. Werdin C, Limas C, Knodell RG. Primary malignant melanoma of the rectum. Evidence for origination from rectal mucosal melanocytes. Cancer. 1988; 61: 1364–1370. [DOI] [PubMed] [Google Scholar]
- 18. Sanchez AA, Wu TT, Prieto VG, et al. Comparison of primary and metastatic malignant melanoma of the esophagus: clinicopathologic review of 10 cases. Arch Pathol Lab Med. 2008; 132: 1623–1629. [DOI] [PubMed] [Google Scholar]
- 19. Zhong J, Zhou JN, Xu FP, et al. Diagnosis and treatment of anorectal malignant melanoma—a report of 22 cases with literature review. Ai Zheng. 2006; 25: 619–624. [PubMed] [Google Scholar]
- 20. Tomicic J, Wanebo HJ. Mucosal melanomas. Surg Clin North Am. 2003; 83: 237–252. [DOI] [PubMed] [Google Scholar]
- 21. Das G, Gupta S, Shukla PJ, et al. Anorectal melanoma: a large clinicopathologic study from India. Int Surg. 2003; 88: 21–24. [PubMed] [Google Scholar]
- 22. Moreno E Solaz, Morales M Vallalta, Búrdalo G Silla, et al. Primary melanoma of the rectum: an infrequent neoplasia with an atypical presentation. Clin Transl Oncol. 2005; 7: 171–173. [DOI] [PubMed] [Google Scholar]
- 23. Biyikoglu I, Oztürk ZA, Köklü S, et al. Primary anorectal malignant melanoma: two case reports and review of the literature. Clin Colorectal Cancer. 2007; 6: 532–535. [DOI] [PubMed] [Google Scholar]
- 24. Stroh C, Manger T. Primary amelanotic anorectal melanoma—a case report. Zentralbl Chir. 2007; 132: 560–563. [DOI] [PubMed] [Google Scholar]
- 25. Helmke BM, Otto HF. Anorectal melanoma. A rare and highly malignant tumor entity of the anal canal. Pathologe. 2004; 25: 171–177. [DOI] [PubMed] [Google Scholar]
- 26. Yap LB, Neary P. A comparison of wide local excision with abdominoperineal resection in anorectal melanoma. Melanoma Res. 2004; 14: 147–150. [DOI] [PubMed] [Google Scholar]
- 27. Moozar KL, Wong CS, Couture J. Anorectal malignant melanoma: treatment with surgery or radiation therapy, or both. Can J Surg. 2003; 46: 345–349. [PMC free article] [PubMed] [Google Scholar]
- 28. Podnos YD, Tsai NC, Smith D, et al. Factors affecting survival in patients with anal melanoma. Am Surgeon. 2006; 72: 917–920. [PubMed] [Google Scholar]
- 29. Maqbool A, Lintner R, Bokhari A, et al. Anorectal melanoma—3 case reports and a review of the literature. Cutis. 2004; 73: 409–413. [PubMed] [Google Scholar]
- 30. Pello MJ, Chang O, Camishion RC. Malignant melanoma of the anal canal. J Med Soc N J. 1983; 80: 42–43. [PubMed] [Google Scholar]
- 31. Weyandt GH, Becker JC. Prognostic factors and therapy for primary anorectal melanoma. Int J Colorectal Dis. 2006; 21: 488–489. [DOI] [PubMed] [Google Scholar]