Anorectal melanoma: experience from a tertiary cancer care centre in South India

Abstract

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.

Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature

“…There was wide variation in the type of surgical management across studies. At some centers, all patients received WE while other centers treated all patients with APR[ 10 , 19 , 20 ].…”

“…Asian (China, South Korea, Japan, and Taiwan) and Indian cohorts had higher rates of APR with 69.9% (200/286) and 79.7% (51/64) of patients receiving APR as primary surgical therapy respectively. Das et al [ 19 ] and Ranjith et al [ 20 ] report cohorts from India with 100% of patients undergoing APR[ 19 , 20 ].…”

Efficacy and prognosis of surgical treatment in ARMM and its effects on immune and inflammatory profiles

“…Moreover, malignant melanoma in the skin ascribes to excessive ultraviolet irradiation, but, there is no ultraviolet irradiation in ARMM, and its pathogenesis is not fully understood. It is generally assumed that ARMM occurs because of the combined effects of environmental and genetic factors (13). ARMM is prevalent in middle-aged and elderly people, and its incidence rate is overtly higher in women than that in men (14).…”

Anorectal Melanoma

“…In another study of 22 patients with metastatic AM, six patients received dacarbazine while one patient received temozolomide and thalidomide. The median survival in these patients was 9 months [56].…”