Melanoma of the anorectal region: The experience of the National Cancer Institute of Milano☆
Introduction
Primary anorectal melanoma is a rare and aggressive disease accounting for approximately 1% of anal tumors.1 Between 0.4 and 1.6% of all melanomas arise in the anorectal region2 and the anal canal is the most frequent site of melanoma after the skin and retina. The first case of the disease was reported by Moore in 18573 and so far approximately 500 cases have been reported in the literature.4, 5, 6, 7, 8, 9, 10, 11 In Italy, out of 3500 new melanoma cases per annum, between 40 and 60 arise in the anorectal region.
Surgical treatment of this specific tumor varies from very extended and radical operations (abdominoperineal resection, APR, or pelvic exenteratio) to extremely conservative procedures such as local excision (LE) or simple medical therapies.1, 4, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 This great discrepancy is mainly due to the difficulty in accruing a significant number of patients and consequently to settling on conclusive guidelines of therapy. In order to start establishing such guidelines, this study reports on the experience of the National Cancer Institute of Milano over the last 32 years in the management and treatment of this rare tumor.
Section snippets
Patients
A total number of 61 consecutive patients affected with primary anorectal melanoma have been treated at the National Cancer Institute of Milan between 1975 and 2006. Of these, only 40 were completely evaluable from a clinical point of view and therefore entered in the present study. Signs and symptoms, operative records and pathological features were reviewed. We also reviewed preoperative radiological examinations: chest X-rays, superior abdomen ultrasounds, computed axial tomography of the
Patient characteristics and symptoms
Main patient and disease characteristics are summarized in Table 1. Patients were sufficiently balanced between treatment groups for gender (globally, 19 males and 21 females) and age (globally, median age 63 years, interquartile [IQ] range: 53–70). Most patients had disease located in the anus, mainly N- and M-, while only four patients presented tumors located in the rectum. Most patients complained of one or more symptoms whose median duration was 5 months. The most frequent initial symptom
Discussion
The treatment of skin melanoma, both medically and surgically, is presently well defined.
However, clear guidelines for the therapy of anal melanomas are not completely settled. This is mainly due to the rarity of this disease and to the difficulty in collecting a consistent number of cases in a homogeneous and rational way. Moreover, the different surgical adopted options have not been directly compared.
Conclusion
The rarity of this disease stops the possibility to draw a randomized study comparing different modalities of therapy for this cancer and the present conclusion should be read under the light of this limitation.
Anyway our policy of offering wide local excision for treatment of localized anorectal melanoma seems to have met the goals of minimizing treatment morbidity without increasing the risk of diffusion of disease. Most recurrences occur systemically, regardless of initial surgical therapy
Conflict of interest
All the Authors declare to have none financial and personal relationships with other people or organizations that could inappropriately influence our work.
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This study was partially supported by AIRC (Italian Association for Cancer Research).