Multimodality Treatment in the Management of Anorectal Melanoma: A Case Report and Review of the Literature

Abstract

Anorectal melanoma represents approximately 0.2-1% of all malignant melanomas and has a poor prognosis, with a median survival of 8 to 23 months after the time of diagnosis. The typical treatment modalities include surgery, radiotherapy and chemotherapy. The particular approach taken depends on the patient's status and disease stage. Although there are different treatment options for this rare condition, there are not enough studies on multimodality treatment. Here, we present the case of a 54-year-old female with anorectal melanoma that had metastasized to an inguinal lymph node. She underwent local excision of the rectal mass and inguinal lymph-node dissection. Temozolomide treatment was started after radiotherapy and was given for 24 months. Follow-up revealed that the patient has been doing well with no signs of recurrence three years after the completion of treatment. We aim to discuss combined treatment modalities for ARM in light of the pertinent literature. Key Words: Anorectal melanoma, Multimodality treatment, Temozolomide ÖzetAnorektal melanoma; tüm malign melanoma vakalarının yaklaşık %0.2-1'ini oluşturmaktadır ve tanı anından itibaren 8-23 ay arasi ortalama yaşam süresiyle kötü bir prognoza sahiptir. Tedavi seçenekleri, hastanın performans skoru ve hastalık evresine gore cerrahi, radyoterapi ve kemoterapiden oluşmaktadır. Bu nadir durumun farkli tedavi seçenekleri olmasına rağmen multimodalite tedavi ile ilgili yeterli calışma bulunmamaktadır. Bu yazıda inguinal lenf nodu metastazı olan 54 yaşında bir bayan hasta sunulmuştur. Rektal kitlenin lokal eksizyonu ve inguinal lenf nodu diseksiyonunu takiben konvansiyonel radyoterapi uygulanan hastaya bu tedaviyi takiben 2 yıl süreyle temozolomide tedavisi verilmiştir. Tedavinin tamamlanmasından 3 yıl sonraki takiplerinde hastada henüz rekurrens bulgusuna rastlanmamıştır. Bu yazıda anorektal melanomanin multimodalite tedavisinin ilgili literatür ışığında tartışılması amaçlanmıştır.

Primary Anorectal Melanoma : A Rare Case Report with Review of Literature

“…Malignant melanoma of the rectum is rare and has very poor prognosis. The incidence has been reported to be 0.4-3% of all malignant melanoma and 0.1-4.6% of all anorectal malignant tumors (4,5) . Melanomas of the anorectum are the most common after melanomas of the skin and retina.…”