Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Methods This study describes a retrospective analysis of 31 cases of anorectal melanoma presented to our centre between January 2001 and December 2013. Results Twenty-two patients (71%) presented with metastasis and had a median overall survival of nine months. None of the 22 patients survived for two years. Nine patients (29%) had curative surgery, in the form of abdominoperineal resection (six patients), abdominoperineal resection with bilateral inguinal node dissection (one patient), abdominoperineal resection with liver resection (one patient) and posterior exenteration (one patient). In patients who underwent curative surgery, the median overall survival was 15 months and disease-free survival was nine months, with a two-year overall survival of 22%. Conclusions Anorectal melanoma is an aggressive disease with a poor prognosis. The majority of patients present with distant metastases. Prognosis depends on stage at presentation. Early diagnosis and surgical resection may improve the overall outcome. Newer modalities such as immunotherapy and targeted therapies such as anti-CTLA4 monoclonal antibody and anti-programmed cell death protein 1 monoclonal antibodies have radically changed the management of mucosal melanoma and may, in the future, improve the overall prognosis of anorectal melanoma.

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Leiomyomas are benign tumours of smooth muscle origin and can occur in any part of the body with adrenal gland being an uncommon site. Ganglioneuromas of adrenal gland are benign neural crest-derived tumours. Both of these tumours are usually detected incidentally. Hereby, the authors report an unusual case of a 31-year-old woman, who presented with paroxysmal attacks of headache, palpitations and flushing pointing towards a hormone secreting adrenal tumour. However, functional adrenal markers were normal. Radiological investigations revealed 8×3 cm heterogeneously enhancing left suprarenal mass with calcification and extension to left renal vein. Patient underwent left nephrectomy and adrenalectomy with a high clinical suspicion of malignancy because of tumour extension to the renal vein. The histopathological examination revealed a leiomyoma arising in a background of ganglioneuroma which was later on confirmed using immunohistochemistry. Authors have presented the present case because of atypical presentation as a hormone secreting adrenal tumour with radiological features of malignancy and the unique histomorphology of the combined occurrence of leiomyoma and ganglioneuromatous area in the adrenal gland. To the best of author’s knowledge, this is the first case report of such an occurrence in the adrenal gland.

Background: Morbidity of axillary dissection includes prolonged lymphatic drainage, surgical site infections, haematoma, flap necrosis and seroma. These complications are likely to delay wound healing and thereby delay administration of adjuvant treatments. Ultrasonic dissection device, the Harmonic Scalpel@, is a recent addition into the breast. Ultrasonic dissection reduces blood loss and reduces post-operative drain and seroma formation, without the use of surgical clips and ties. We hypothesised that axillary lymph node dissection (ALND) performed with ultrasonic dissection will decrease post-operative drain volume and number of days the patient is put on drain. Here, we present our randomised controlled trial study to compare the outcomes of ALND using ultrasonic dissection (harmonic scalpel) with standard electrocautery. Methods: A total of 113 patients were randomised to two arms - the control arm underwent ALND by standard electrocautery dissection and the experimental arm underwent axillary dissection with ultrasonic scalpel. The primary objectives were (1) to measure the total post-operative drainage volume and (2) the total number of days with drain. Results: The total drainage was significantly less in the intervention arm with a P = 0.015. However, the total number of days on drain was not significantly different in both the arms. The drainage on the 1st post-operative day, which indirectly measures haemostatic capacity, was also not different between the two groups. Conclusion: Although ultrasonic dissection of the axilla significantly reduces the total drain output, the total days the patients spent with drain in situ was not significantly different. The operating time was significantly increased with ultrasonic dissection. Hence, with this study, the routine use of ultrasonic dissection could not be recommended.