Ano-uro-genital mucosal melanoma UK national guidelines

Smith, Henry; Bagwan, Izhar; Board, Ruth; Capper, Sharon; Coupland, Sarah E.; Glen, J. B.; Lalondrelle, Susan; Mayberry, Antonia; Muneer, Asıf; Nugent, Karen; Pathiraja, Pubudu; Payne, Miranda; Peach, Howard; Smith, Jonathan; Westwell, S.; Wilson, Ewan; Rodwell, Simon; Gore, Martin; Turnbull, Nancy; Smith, Myles

doi:10.1016/j.ejca.2020.04.030

Cited by 40 publications

(92 citation statements)

References 12 publications

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“…A correlation analysis of the MRI findings with the clinical aspects concluded that a polypoid mass in the anorectum without obstruction, with T1 hyperintensity, T2 mixed signal intensity, hyperenhancement, adjacent infiltration, and lymphadenopathies, can be considered characteristic[ 15 ]. In addition to MRI and CT scans, PET-CT and MRI of the brain can be considered preoperatively if radical resection is planned[ 16 ]. Additionally, PET-CT is superior for the evaluation of patients with locoregional and systemic involvement[ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…A site-specific staging method is missing from the 8 th edition of the American Joint Committee on Cancer (AJCC) staging system[ 7 , 16 ], so three systems are currently used: Clinical system, rectal TNM staging system, and anal TNM staging system. Although the differences are not significant regarding prognosis, it has been concluded that the accuracy of prognosis in patients diagnosed with stage III anorectal melanoma would be improved using the rectal TNM staging system, with additional information about the number of lymph node metastases[ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgery is the most effective treatment but is not associated with improvement in overall survival[ 5 ]. Resection with curative or palliative intent can be performed by EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) as wide local excision or abdominoperineal resection[ 16 ]. Curative intent is associated with stage I and some stage II patients[ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Difficulties in diagnosing anorectal melanoma: A case report and review of the literature

Apostu¹,

Ştefănescu²,

Scurtu³

et al. 2021

WJCC

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BACKGROUND Anorectal melanoma is a tumour that is difficult to identify due to its rarity and variability of presentation. Insufficient data published in the literature do not allow for diagnostic and treatment guidelines to be established. Anorectal melanoma has the worst prognosis among mucosal melanomas and is frequently misdiagnosed by standard identification methods. CASE SUMMARY A 66-year-old woman presented with intermittent anal bleeding, pain, and tenesmus in the past month, with no associated weight loss. Colonoscopy revealed a cauliflower-like tumour with a diameter of 1.5 cm, with exulcerated areas and an adherent clot but without obstruction. Biopsy results identified an inflammatory rectal polyp with nonspecific chronic rectitis. Tumour markers CA 19-9 and CEA were within the normal range. After 6 mo, due to the persistence of symptoms, a pelvic magnetic resonance imaging scan was performed. A lesion measuring 2.8 cm × 2.7 cm × 2.1 cm was identified at the anorectal junction, along with two adjacent lymphadenopathies. No distant metastases were detected. Immunohistochemistry was performed on the second set of biopsies, and a diagnosis of anorectal melanoma was established. Surgical treatment by abdominoperineal resection was performed. Evolution was marked by the appearance of lung metastases at 1 mo postoperatively, detected on a positron emission tomography-computer tomography scan, and perineal recurrence after 5 mo. After molecular testing, the patient was included in an immunotherapy trial. CONCLUSION This case highlights the difficulty of establishing a definitive early diagnosis of anorectal melanoma, the importance of performing histological analysis on a well-represented biopsy specimen, and the poor prognosis, even with radical surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Difficulties in diagnosing anorectal melanoma: A case report and review of the literature

Apostu¹,

Ştefănescu²,

Scurtu³

et al. 2021

WJCC

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“…Finally, in 2020, a series of authors developed UK national guidelines [117], aiming to make the diagnostic-therapeutic assistance (PDTA) pathways of patients with uro-genital tract melanoma more uniform, clear and easily accessible, starting from the evidence in the literature. After briefly summarizing the evidence from case reports and case series present in the literature and discussing the main histomorphological and immunophenotypic characteristics, as well as molecular biology, the authors underline that the best treatment approach aimed at modifying the (rather low) survival rates of patients with MM should be based on the most up-to-date guidelines, and in this regard their recommendations are to: (1) use single-agent programmed cell death protein 1 (PD1) antibodies in patients with unresectable stage III or stage IV tumors, but taking into account any contraindications to this therapy; (2) consider combination immunotherapy, for example, anti-CTLA (cytotoxic T-lymphocyte-associated protein and anti-PD1/PD-L1 (programmed cell death ligand monoclonal antibodies in selected, fit patients; (3) consider BRAF + MEK inhibitors as a treatment option for the small number of patients with BRAF mutated unresectable stage III or stage IV MM: (4) in all cases where there is no clearly predominant risk/benefit ratio for any therapeutic approach, inform the patient about all the existing possibilities and choose together.…”

Section: Urethra and Penismentioning

confidence: 99%

Urological Melanoma: A Comprehensive Review of a Rare Subclass of Mucosal Melanoma with Emphasis on Differential Diagnosis and Therapeutic Approaches

Cazzato

Colagrande

Cimmino

et al. 2021

Cancers

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Melanoma is reported as the 19th most common cancer worldwide, with estimated age-standardized incidence rates of 2.8–3.1 per 100,000. Although the origin is most frequently cutaneous, mucosal melanoma has been described several times in literature, and despite its rarity (only 1% of all melanomas), increasing attention is being paid to this disease form. Within this subgroup, melanomas of the uropoetic apparatus are a rarity among rarities. Indeed, less than 50 cases of primary melanoma originating from the urinary bladder have been described, and even less originating from the kidney, renal pelvis and urethra. In this work, we present a detailed review of the literature related to this subclass of mucosal melanoma, delve into the biological landscape of this neoplasm and discuss current approaches, future perspectives and potential therapeutic approaches.

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“…The systemic dissemination of the disease occurs early in the course of the disease even before lymph nodal metastasis [43]. The 2020 UK National guidelines recommend R0 surgical resection in the least radical fashion [44]. Lymphadenectomy should be performed in cases with metastatic regional lymph nodes.…”

Section: Surgerymentioning

confidence: 99%

Anorectal Melanoma

Gupta¹,

Bansal²,

Ammar³

et al. 2021

Melanoma

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Malignant melanoma is an aggressive disease. The anorectal region is the most common site of primary gastrointestinal malignant melanoma. Due to its low incidence, the diagnosis is often delayed. The most characteristic clinical feature of this tumor is its brown-black appearance due to the melanin pigment. However, the pigmentation may be absent in up to 20% cases. Timely diagnosis and treatment are crucial for achieving good long-term outcomes. Surgical excision remains the treatment of choice for localized disease. However, the extent of surgery has been a matter of debate. Anorectal melanoma is a highly malignant disease, and more than 50% cases have metastasis at the time of diagnosis. Targeted therapies especially immune check point inhibitors have brought about a paradigm shift in the management of cutaneous melanoma. They are being increasingly used for mucosal melanomas, and their role in anorectal melanoma is being investigated in various clinical trials.

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Ano-uro-genital mucosal melanoma UK national guidelines

Cited by 40 publications

References 12 publications

Difficulties in diagnosing anorectal melanoma: A case report and review of the literature

Difficulties in diagnosing anorectal melanoma: A case report and review of the literature

Urological Melanoma: A Comprehensive Review of a Rare Subclass of Mucosal Melanoma with Emphasis on Differential Diagnosis and Therapeutic Approaches

Anorectal Melanoma

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