Surgical therapy for anorectal melanoma
- 28 February 2003
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 196 (2), 206-211
- https://doi.org/10.1016/s1072-7515(02)01538-7
Abstract
Background Anorectal melanoma is a rare but highly lethal malignancy. Historically, radical resection was considered the “gold standard” for treatment of potentially curable anorectal melanoma. The dismal prognosis of this disease has prompted us to recommend wide local excision as the initial therapeutic approach. The purpose of this study was to review our results in patients who underwent wide local excision or radical surgery (abdominoperineal resection [APR]) for localized anorectal melanoma. Study design We reviewed the charts of all patients referred for resection of anorectal melanoma between 1988 and 2002. Endpoints included overall survival, disease-free survival, and local, regional, or systemic recurrence. Results Fifteen patients underwent curative-intent surgery; four underwent APR and 11 underwent wide local excision. Eight patients (53%) are alive; 7 (47%) are disease-free (followup 6 months to 13 years). Of 12 patients who have been followed for more than 2 years, 4 are alive (33%) and 3 are disease-free (25%). Seven patients have been followed for more than 5 years and two are alive and disease-free (29%). All of the longterm survivors underwent local excision as the initial operation. There were no differences in local recurrence, systemic recurrence, disease-free survival, or overall survival between the APR group and the local excision group. Local recurrence occurred in 50% of the APR group and 18% of the local excision group; regional recurrence occurred in 25% versus 27%. Distant metastases were common (75% versus 36%). Conclusion In patients who have undergone resection with curative intent for anorectal melanoma, most recurrences occur systemically regardless of the initial surgical procedure. Local resection does not increase the risk of local or regional recurrence. APR offers no survival advantage over local excision. We advocate wide local excision as primary therapy for anorectal melanoma when technically feasible.Keywords
This publication has 42 references indexed in Scilit:
- Long-Term Results of a Multi-Institutional Randomized Trial Comparing Prognostic Factors and Surgical Results for Intermediate Thickness Melanomas (1.0 to 4.0 mm)Annals of Surgical Oncology, 2000
- The use of endoluminal ultrasound for malignant and benign anorectal diseasesCurrent Opinion in Gastroenterology, 1997
- Anorectal melanoma in The Netherlands: a report of 63 patientsEuropean Journal of Surgical Oncology, 1996
- Randomized Trial of Adjuvant Human Interferon Gamma Versus Observation in High-Risk Cutaneous Melanoma: a Southwest Oncology Group StudyJNCI Journal of the National Cancer Institute, 1995
- Carcinoma of the rectumDiseases of the Colon & Rectum, 1994
- Synchronous abdominoperineal resection without transfusionBritish Journal of Surgery, 1993
- Anorectal melanomaDiseases of the Colon & Rectum, 1982
- A Randomized Trial of Adjuvant Chemotherapy and Immunotherapy in Cutaneous MelanomaThe New England Journal of Medicine, 1982
- Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectumDiseases of the Colon & Rectum, 1982
- A comparative study of melanoma and epidermoid carcinoma of the anal canal: A review of 20 melanomas and 29 epidermoid carcinomas (1930 to 1965)Diseases of the Colon & Rectum, 1967