Malignant Melanoma of Anorectum: A Report of Five Cases
Main Article Content
Abstract
BACKGROUND: Anorectal melanoma (ARM) is an extremely rare, highly aggressive form of a tumor with the worst prognosis. ARM contributes 0.5% of all melanoma cases. Its presentation is similar to that of adenocarcinoma of the rectum, hemorrhoids, or solitary rectal ulcer, the incorrect clinical diagnosis or delayed diagnosis is often made. The definite diagnosis is only made through histopathology in which immunohistochemical stains positive to S-100, Melan A, and HMB-45 which differentiates it from adenocarcinoma of the rectum.
Because of the limited number of patients and retrospective design of studies to date, there is no proven efficacy of abdominoperineal resection (APR) over local excision (LE) in terms of survival. Furthermore, this neoplasm is quite resistant to chemoradiotherapy. It has a median survival of 18 months and a 5-year survival rate of only 6%.
PRESENTATION OF OUR CASES: Here, we report 5 rare cases of anorectal malignant melanoma presented to our institute between 2018 to 2022, who were treated with APR and diversion colostomy. The first case is a 27-years old young female with typical complaints, she was diagnosed ARM with locoregional metastasis. Only a diversion colostomy was performed and referred to an oncologist for palliation. Our second case is a 68-years old male with a similar complaint who presented relatively early and was diagnosed with localized disease. Conventional APR was performed and referred for adjuvant chemoradiotherapy, but the patient refused. However, the lump recurred after 6 months of tumor excision. The third case is a 29 years old male again early presentation with a similar complaint labeled as localized diseased. The conventional APR was performed followed by adjuvant chemoradiation; patient presented with metastatic disease after 6 months. The fourth case is a 60-years old male with typical history and diagnosed with localized disease. Conventional Extra-levator APR was performed followed by adjuvant therapy, but patient developed recurrence of disease with mets after 4 months. The fifth case is a 39-years old female diagnosed as ARM, had advance disease and metastatic deposits at the time of presentation, refused any palliative treatment. The study aims to evaluate our experience in treating this neoplasm.
CONCLUSION: Because of the rarity of this neoplasm, no proper trial has been conducted so far. The role of chemoradiotherapy is questionable and the surgical approach varies from radical APR to conservative LE. No surgical approach has been standardized in terms of survival.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Heppt MV, Roesch A, Weide B, Gutzmer R, Meier F, Loquai C, et al. Prognostic factors and treatment outcomes in 444 patients with mucosal melanoma. 2017;81:36-44.
3. Singh R, Mahajan P, Rajdev V, Singh J, andKartik Rana VSJIJoS. Anal canal melanoma-a rare entity: A case report and review of literature. 2022;6(3):04-8.
4. Singh R, Mahajan P, Rajdev V, Singh J, Singhal VJJG, Digestive Systems. Anal Canal Melanoma A Case Report and Review of Literature. 2022;100.
5. Kusuma MI, Sampetoding S, Ferdinandes F, Faruk MJNMSJ. Malignant Melanoma of Anorectal: A Report of Two Cases. 2022:12-20.
6. Galante J, Adeleke S, Parkar R, Bagla N, Edwards A, Boussios S, et al. Metastatic Anorectal Melanoma Presenting as Seizures: An Infrequent Culprit. 2022;10(2):21.
7. Stefanou A, Nalamati SP. Anorectal Melanoma. Clin Colon Rectal Surg. 2011;24:171–6. [PMC free article] [PubMed] [Google Scholar]
8. Row D, Weiser MR. Anorectal melanoma. Clin Colon Rectal Surg. 2009;22:120–6. [PMC free article] [PubMed] [Google Scholar]
9. Garg V, Rastogi S, Aswar H, Shamim SA, Dhamija E, Barwad A, et al. Clinicopathological profile and outcomes of anorectal melanoma from a tertiary care center in India. 2022;8(4):FSO786.
10. Husain M, Rashid T, Ahmad MM, Hassan MJJJoCR, Therapeutics. Anorectal malignant amelanotic melanoma: Report of a rare aggressive primary tumor. 2022;18(1):249.
11. Slingluff CL, Jr, Vollmer RT, Seigler HF. Anorectal melanoma: Clinical characteristics and results of surgical management in twenty-four patients. Surgery. 1990;107:1–9. [PubMed] [Google Scholar]
12. Liptrot S, Semeraro D, Ferguson A, Hurst N. Malignant melanoma of the rectum: A case report. J Med Case Rep. 2009;3:9318. [PMC free article] [PubMed] [Google Scholar]
13. Singer M, Mutch MG. Anal melanoma. Clin Colon Rectal Surg. 2006;19:78–87. [PMC free article] [PubMed] [Google Scholar]
14. Van Schaik PM, Ernst MF, Meijer HA, Bosscha K. Melanoma of the rectum: A rare entity. World J Gastroenterol. 2008;14:1633–5. [PMC free article] [PubMed] [Google Scholar]
15. Kuka WP, Gatheru J, Mwanzi S, Onyango N, Rajula A. Primary rectal melanoma in an African female: case report.
16. Lerner BA, Stewart LA, Horowitz DP, Carvajal RDJO. Mucosal Melanoma: new insights and therapeutic options for a unique and aggressive disease. 2017;31(11).
17. Alkhamiss AS, Al Abdulmonem WI, Alsalloom AA, Alsolai AM, Alorini MA, Aljaradi MA, et al. Anorectal Melanoma: Unexpected tumor in unexpected population. 2020;14(4):47-9.
18. Carcoforo P, Raiji M, Palini G, Pedriali M, Maestroni U, Soliani G, et al. Primary anorectal melanoma: an update. 2012;3:449.
19. Wagner JD, Gordon MS, Chuang T-Y, Coleman 3rd JJP, surgery r. Current therapy of cutaneous melanoma. 2000;105(5):1774-99; quiz 800.