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El Achchi A, Majdoubi A, El Hammouti M, Bouhout T, Serji B. Anorectal melanoma: Report of two cases. Int J Surg Case Rep 2025; 126:110621. [PMID: 39706148 PMCID: PMC11718282 DOI: 10.1016/j.ijscr.2024.110621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 12/23/2024] Open
Abstract
INTRODUCTION Anorectal melanoma (AM) is a rare and aggressive type of cancer. Its symptoms often resemble those of common benign anal conditions, such as hemorrhoids, leading to frequent delays in diagnosis. Consequently, about one-third of patients have metastases at the time of their initial diagnosis. The primary treatment for AM is surgical resection, while adjuvant therapies may include immunotherapy, radiotherapy, brachytherapy, and chemotherapy. The prognosis for AM is poor, with a five-year survival rate of only 20 %. CASE PRESENTATION In this study, we report two cases of patients who experienced different anorectal symptoms for a long time before their condition worsened, prompting further investigation that revealed a diagnosis of malignant anorectal melanoma. Both patients underwent surgical resection and are currently receiving adjuvant therapy. DISCUSSION This article discusses the prognosis of anorectal melanoma, the current lack of consensus on treatment protocols, and the importance of maintaining a high index of suspicion for early diagnosis. CONCLUSION Anorectal melanoma is a rare pathology, and its prognosis is poor due to the frequent presence of metastatic forms at the time of diagnosis. Surgery, whether through abdominoperineal amputation or wide local excision, is the treatment of choice for these tumors. The use of radiotherapy (RT) is controversial and is currently indicated either as hypofractionated therapy following local excision (EL) or as palliative treatment.
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Affiliation(s)
- Anass El Achchi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco.
| | - Amine Majdoubi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Mohamed El Hammouti
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tarek Bouhout
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Badr Serji
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
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Souhaib A, Yacine O, Mahdi H, Amine S, Anis H, Kacem M. Anorectal melanoma: A case report of an unusual localization. Int J Surg Case Rep 2024; 125:110458. [PMID: 39536673 PMCID: PMC11605388 DOI: 10.1016/j.ijscr.2024.110458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/10/2024] [Accepted: 10/11/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary anorectal melanoma (ARM) is a rare neoplasm with an extremely poor prognosis. It represents less than 1 % of all melanomas and accounts for less than 1 % of anorectal malignancies. We report a case of anorectal primary melanoma treated surgically. CASE PRESENTATION A 73-year-old presented with a rectal syndrome evolving over 3 months, associated with rectal bleeding and sub-occlusive syndromes progressing in the context of general deterioration. Anal margin examination showed a protruding lesion with blackish color of the anal mucosa. Biopsies with histopathological examination concluded a malignant melanoma with necrotic changes. Locoregional staging with thoracic-abdominal-pelvic CT scan revealed a suspicious thickening of the rectum's lower wall contacting the posterior wall of the vagina, with loss of fat stranding associated with multiple mesorectal lymph nodes without distant secondary lesions. A laparoscopic proctectomy was performed. A histopathological examination of the specimen confirmed the diagnosis with clean margins. The patient recovered uneventfully. DISCUSSION Anorectal melanoma is an exceedingly rare form of cancer, comprising less than 1 % of all anorectal malignancies. Surgical intervention remains the primary treatment modality for anorectal melanoma. Abdominoperineal resection has traditionally been the mainstay approach. Studies have suggested that localized excision coupled with adjuvant therapies such as low-dose radiotherapy may offer comparable local control rates to traditional abdominopelvic resection while preserving sphincter function and quality of life. CONCLUSION Anorectal melanoma is a rare disease with poor prognosis. The lack of high-volume data researches shows the missing guideline for this disease.
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Affiliation(s)
- Atri Souhaib
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ouadi Yacine
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Hammami Mahdi
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sebei Amine
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Haddad Anis
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Montasser Kacem
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Shannon AB, Zager JS, Perez MC. Clinical Characteristics and Special Considerations in the Management of Rare Melanoma Subtypes. Cancers (Basel) 2024; 16:2395. [PMID: 39001457 PMCID: PMC11240680 DOI: 10.3390/cancers16132395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Rare histologic subtypes of melanoma, including acral, mucosal, uveal, and desmoplastic melanomas, only make up 5% of all diagnosed melanomas and are often underrepresented in large, randomized trials. Recent advancements in systemic therapy have shown marked improvement in pathologic response rates, improving progression-free and overall survival among cutaneous melanoma patients, but there are limited data to demonstrate improved survival among rarer subtypes of melanoma. Acral melanoma has a poor response to immunotherapy and is associated with worse survival. Mucosal melanoma has a large variability in its presentation, a poor prognosis, and a low mutational burden. Uveal melanoma is associated with a high rate of liver metastasis; recent adoption of infusion and perfusion therapies has demonstrated improved survival among these patients. Desmoplastic melanoma, a high-risk cutaneous melanoma, is associated with high locoregional recurrence rates and mutational burden, suggesting this melanoma may have enhanced response to immunotherapy. While these variants of melanoma represent distinct disease entities, this review highlights the clinicopathologic characteristics and treatment recommendations for each of these rare melanomas and highlights the utility of modern therapies for each of them.
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Affiliation(s)
- Adrienne B Shannon
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Matthew C Perez
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Fadel MG, Mohamed HS, Weir J, Hayes AJ, Larkin J, Smith MJ. Surgical Management of Primary Anorectal Melanoma: Is Less More? J Gastrointest Cancer 2024; 55:714-722. [PMID: 38180677 PMCID: PMC11186905 DOI: 10.1007/s12029-023-01009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Ano-uro-genital (AUG) Mucosal Melanoma UK guidelines recommended a less radical surgical strategy for anorectal melanoma (ARM) where possible. We report our experience of ARM consistent with that approach including clinical presentation, intervention undertaken and prognosis. METHODS We present a retrospective study of 15 consecutive patients with ARM surgically treated between November 2014 and April 2023. Patients were divided into the two surgery types: wide local excision (WLE, n = 9) and abdominoperineal resection (APR, n = 6). Data on demographics, diagnosis, treatment and oncological outcomes were assessed between the groups. RESULTS The mean age was 65.3 ± 17.4 years and 6 (40.0%) were female patients. Nine patients (60.0%) were diagnosed with stage I and six patients (40.0%) with stage II disease. R0 margins were achieved in all cases. The overall mean length of stay was lower following WLE compared to APR (2.6 ± 2.4 days versus 14.0 ± 9.8 days, p = 0.032). Two complications were observed in the WLE group compared to four complications after APR (p = 0.605). Five patients (55.5%) developed local/distant recurrence in the WLE group compared to three patients (50.0%) in the APR group (p = 0.707), with a median overall survival of 38.5 (12-83) months versus 26.5 (14-48) months, respectively. CONCLUSIONS Achieving clear margins by the least radical fashion may have equivalent oncological outcomes to radical surgery, potentially reducing patient morbidity and preserving function. In our experience, the surgical management of ARM consistent with the 'less is more' approach adhering to AUG guidelines has acceptable outcomes.
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Affiliation(s)
- Michael G Fadel
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Hesham S Mohamed
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Justin Weir
- Department of Cellular Pathology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Andrew J Hayes
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - James Larkin
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- Department of Medical Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Myles J Smith
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Wei AZ, Chen LN, Orloff M, Ariyan CE, Asgari M, Barker CA, Buchbinder E, Chandra S, Couts K, Frumovitz MM, Futreal A, Gershenwald JE, Hanna EY, Izar B, LeBlanc AK, Leitao MM, Lipson EJ, Liu D, McCarter M, McQuade JL, Najjar Y, Rapisuwon S, Selig S, Shoushtari AN, Yeh I, Schwartz GK, Guo J, Patel SP, Carvajal RD. Proceedings from the Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA). Pigment Cell Melanoma Res 2023; 36:542-556. [PMID: 37804122 DOI: 10.1111/pcmr.13139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
Mucosal melanoma remains a rare cancer with high mortality and a paucity of therapeutic options. This is due in significant part to its low incidence leading to limited patient access to expert care and downstream clinical/basic science data for research interrogation. Clinical challenges such as delayed and at times inaccurate diagnoses, and lack of consensus tumor staging have added to the suboptimal outcomes for these patients. Clinical trials, while promising, have been difficult to activate and accrue. While individual institutions and investigators have attempted to seek solutions to such problems, international, national, and local partnership may provide the keys to more efficient and innovative paths forward. Furthermore, a mucosal melanoma coalition would provide a potential network for patients and caregivers to seek expert opinion and advice. The Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA) highlighted the current clinical challenges faced by patients, providers, and scientists, identified current and future clinical trial investigations in this rare disease space, and aimed to increase national and international collaboration among the mucosal melanoma community in an effort to improve patient outcomes. The included proceedings highlight the clinical challenges of mucosal melanoma, global clinical trial experience, basic science advances in mucosal melanoma, and future directions, including the creation of shared rare tumor registries and enhanced collaborations.
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Affiliation(s)
- Alexander Z Wei
- Columbia University Irving Medical Center, New York, New York, USA
| | - Lanyi N Chen
- Columbia University Irving Medical Center, New York, New York, USA
| | - Marlana Orloff
- Thomas Jefferson University Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Sunandana Chandra
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kasey Couts
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Andrew Futreal
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Ehab Y Hanna
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin Izar
- Columbia University Irving Medical Center, New York, New York, USA
| | - Amy K LeBlanc
- National Institute of Health, Bethesda, Maryland, USA
| | - Mario M Leitao
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Evan J Lipson
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Liu
- Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, Massachusetts, USA
| | - Martin McCarter
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Yana Najjar
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | | | - Sara Selig
- Melanoma Research Foundation, CURE OM, Washington, DC, USA
| | | | - Iwei Yeh
- University of California, San Francisco, San Francisco, California, USA
| | | | - Jun Guo
- Peking University Cancer Hospital & Institute, Beijing, China
| | - Sapna P Patel
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Zeng J, Zhu L, Zhou G, Pan F, Yang Y. Prognostic models based on lymph node density for primary gastrointestinal melanoma: a SEER population-based analysis. BMJ Open 2023; 13:e073335. [PMID: 37798018 PMCID: PMC10565139 DOI: 10.1136/bmjopen-2023-073335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE This study aimed to construct prognostic models to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with primary gastrointestinal melanoma (PGIM). DESIGN An observational and retrospective study. SETTING Data were obtained from the Surveillance, Epidemiology and End Results (SEER) programme database, encompassing a broad geographical and demographic spectrum of patients across the USA. PARTICIPANTS A total of 991 patients diagnosed with PGIM were included in this study. METHODS A total of 991 patients with PGIM were selected from the SEER database. They were further divided into a training cohort and a validation cohort. Independent prognostic factors were identified by Cox regression analysis. Two prognostic models were constructed based on the results of multivariable Cox regression analysis. The concordance index (C-index) and area under the time-dependent receiver operating characteristic curve (time-dependent AUC) were used to evaluate the discriminative ability. Calibration curves were plotted to evaluate the agreement between the probability as predicted by the models and the actual probability. Risk stratification was developed given the model. RESULTS By the multivariable Cox regression analysis, we identified four independent risk factors (age, stage, lymph node density and surgery) for OS, and three independent risk factors (stage, lymph node density and surgery) for CSS, which were used to construct prognostic models. C-index, time-dependent AUC, calibration curves and Kaplan-Meier curves of risk stratification indicated that these two models had good discriminative ability, predictive ability as well as clinical value. CONCLUSIONS The prognostic models of OS and CSS had satisfactory accuracy and were of clinical value in evaluating the prognosis of patients with PGIM.
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Affiliation(s)
- Jiaqi Zeng
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical school of Chinese PLA, Beijing, China
| | - Lin Zhu
- Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- The First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, China
| | - Guanzhou Zhou
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Pan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Temperley HC, O’Sullivan NJ, Keyes A, Kavanagh DO, Larkin JO, Mehigan BJ, McCormick PH, Kelly ME. Optimal surgical management strategy for treatment of primary anorectal malignant melanoma—a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:3193-3200. [DOI: 10.1007/s00423-022-02715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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Liu C, Tang C, Zhang J, Zhu P. Extensive resection improves overall and disease-specific survival in localized anorectal melanoma: A SEER-based study. Front Surg 2022; 9:997169. [PMID: 36111221 PMCID: PMC9468230 DOI: 10.3389/fsurg.2022.997169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anorectal melanoma is a rare tumor with a dismal prognosis. The only promising treatment for anorectal melanoma is surgery, either extensive resection (ER) or local excision (LE). However, the optimal extent of resection is still controversial. The purpose of this study was to investigate whether the survival outcomes of anorectal melanoma at different stages are influenced by the surgical approaches (LE or ER) using the National Institute of Health's Surveillance, Epidemiology, and End Results Program (SEER) database. Methods The Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients treated for anorectal melanoma (2000–2018). Overall survival (OS) and disease-specific survival (DSS) outcomes were compared for the two surgical approaches (ER or LE) stratified by stage (localized, regional and distant). Results A total of 736 patients were included in the study. Details of previous surgical procedures were available for 548 of the study patients: 360 (65.7%) underwent LE, and 188 (34.3%) underwent ER. In localized cases, 199 underwent LE, and 48 underwent ER. The OS (median 45 vs. 29 months, 5-year rate 41.7% vs. 23.4%) and DSS (median 66 vs. 34 months, 5-year rate 51% vs. 30.7%) of patients undergoing ER were significantly better (p = 0.009 and 0.041, respectively) than those who received LE. Multivariate analysis showed that the type of surgery was an independent prognostic factor for both OS and DSS. Among the regional cases, 89 cases had LE, and 96 cases had ER. Patients with regional disease who underwent ER had no significant differences in OS (23 vs. 21 months; p = 0.866) or DSS (24 vs. 24 months; p = 0. 907) compared to patients who underwent LE. In distant cases, 72 cases had LE, and 44 cases had ER. Patients with metastatic disease who had ER also had similar OS (median 11 vs. 8 months; p = 0.36) and DSS (median 11 vs. 8 months; p = 0.593) to those who underwent LE. Conclusion Extensive resection can improve the long-term prognosis of localized anorectal melanoma compared to local excision, but the prognosis of the two surgical techniques is comparable in both regional patients and distant patients.
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Affiliation(s)
- Chang Liu
- Department of Gastrointestinal Anorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cuiping Tang
- Department of cancer center, The Second Affiliated Hospital of Chongqing Medical University, Chong, China
| | - Jianbo Zhang
- Department of Gastrointestinal Anorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Zhu
- Department of Gastrointestinal Anorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Peng Zhu
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Lei X, Qingqing L, Weijie Y, Li P, Huang C, Kexun Y, Zihua C. Effect of surgical treatment for anorectal melanoma: a propensity score-matched analysis of the Surveillance, Epidemiology, and End Results programme data. BMJ Open 2022; 12:e053339. [PMID: 35450893 PMCID: PMC9024256 DOI: 10.1136/bmjopen-2021-053339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Anorectal melanoma (AM) is a rare but aggressive tumour with limited information in the existing literature. This study aimed to assess the effect of surgical treatment for AM and predict the prognosis of affected patients. DESIGN A retrospective cohort study. SETTING Data of patients diagnosed with AM between 1975 and 2016 in the USA were collected from the Surveillance, Epidemiology, and End Results (SEER) database. PARTICIPANTS This study enrolled a total of 795 patients with AM from the SEER database and the validation cohort comprised 40 patients with AM enrolled from Chinese institutes. PRIMARY AND SECONDARY OUTCOME MEASURES Overall survival (OS) and AM-specific survival (AM-SS). RESULTS A total of 795 patients with AM diagnosed between 1975 and 2016 were enrolled in this study. Data over the past four decades showed a trend of increase in incidence rate. A nomogram based on a multivariate Cox regression model was generated to predict AM-SS. The C-index of the nomogram was 0.74 (95% CI 0.71 to 0.77) on internal verification. In the validation cohort, the C-index of the nomogram was 0.72 (95% CI 0.68 to 0.76). The results of propensity score matching (PSM) analysis showed that patients who underwent surgical treatment achieved significant survival (OS: log-rank=17.41, p<0.001; AM-SS: log-rank=14.55, p<0.001). Patients who underwent surgery were stratified into local and extended surgery subgroups. AM-SS and OS were also compared after PSM, but the results were not significantly different between the two surgery subgroups (all p>0.05). CONCLUSIONS The nomogram based on the analysis of SEER data showed good performance in predicting OS and AM-SS. Patients with AM can benefit from surgery; however, extensive surgery and appendectomy may not improve AM-SS or OS.
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Affiliation(s)
- Xiao Lei
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Luo Qingqing
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Yuan Weijie
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Peng Li
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Changhao Huang
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Yu Kexun
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Chen Zihua
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
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10
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Yan J, Jing J, Wu S, Geiru L, Zhuang H. Can transrectal ultrasonography distinguish anorectal malignant melanoma from low rectal adenocarcinoma? A retrospective paired study for ten years. BMC Gastroenterol 2022; 22:165. [PMID: 35382743 PMCID: PMC8985288 DOI: 10.1186/s12876-022-02237-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/24/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Anorectal malignant melanoma (ARMM) and low rectal adenocarcinoma (LRAC) have some similarities in clinical behaviors, histopathological characteristics and ultrasonographic findings, diagnostic errors are common. By comparing the transrectally ultrasonographic features between the two tumors, we propose to provide more possibilities in differentiating them. METHODS The data of 9 ARMMs and 27 age- and gender-matched LRACs (the lower margin below the peritoneal reflection) in West China Hospital Sichuan University between April 2008 and July 2019 were retrospectively reviewed. The ultrasonic features between the two groups were compared. RESULTS Transrectal ultrasonography (TRUS) showed that the length of ARMM was shorter than that of LRAC (28.22 ± 12.29 mm vs. 40.22 ± 15.16 mm), and ARMM had a lower position than that of LRAC (the distance to anal verge was 50.78 ± 11.70 vs. 63.81 ± 18.73 mm). Unlike LRAC, the majority of ARMM in our study was confined to the intestinal mucosa/submucosa (66.67/25.93%) (P < 0.05). CONCLUSIONS Based on the data of our study, several ultrasonographic findings (length, invasion depth, and position) of ARMM were significantly different from LRAC. Accordingly, more attention should be paid to masses at anorectal junction with lower position, shorter length, and shallower infiltration depth. Instead of the most common tumor, LRAC, ARMM should be taken into account to avoid a misdiagnosis, which will result in a poorer prognosis.
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Affiliation(s)
- Jingwen Yan
- Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Jigang Jing
- Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Shuang Wu
- Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Lacong Geiru
- Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Hua Zhuang
- Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Clinicopathological profile and outcomes of anorectal melanoma from a tertiary care center in India. Future Sci OA 2022; 8:FSO786. [PMID: 35369276 PMCID: PMC8965809 DOI: 10.2144/fsoa-2021-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Anorectal melanoma (AM) is a rare subtype of melanoma. Aim: To study the clinic–pathologic features and outcomes in patients with AM. Materials & methods: Clinical, pathologic findings and outcomes of patients with AM were recorded. Results: Twenty-seven patients with AM were identified with median age of 57 years. Most patients presented in stage III (44.4%). Lymph node involvement was seen in 70.4%. The response to chemotherapy and immunotherapy was 16.6 and 25.0%, respectively. At a median follow up of 11 months, median overall survival was 30 months. Ballantine stage 3 and weight loss at presentation were predictors of poor survival. Conclusion: AM presents at an advanced stage with lymph node and distant metastasis. Anorectal melanoma is a rare subset of melanoma presenting at an advanced stage with lymph node and distant metastasis. Early disease is managed surgically; however, optimal treatment of advanced disease is unclear. The stage at diagnosis is the most important prognostic factor. Prognosis is poor, but with the advent of targeted therapy and immunotherapy, the outcomes are improving.
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Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas. Biomedicines 2022; 10:biomedicines10010150. [PMID: 35052829 PMCID: PMC8773579 DOI: 10.3390/biomedicines10010150] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Mucosal melanomas (MM) are rare tumors, being less than 2% of all diagnosed melanomas, comprising a variegated group of malignancies arising from melanocytes in virtually all mucosal epithelia, even if more frequently found in oral and sino-nasal cavities, ano-rectum and female genitalia (vulva and vagina). To date, there is no consensus about the optimal management strategy of MM. Furthermore, the clinical rationale of molecular tumor characterization regarding BRAF, KIT or NRAS, as well as the therapeutic value of immunotherapy, chemotherapy and targeted therapy, has not yet been deeply explored and clearly established in MM. In this overview, focused on anorectal and genital MM as models of rare melanomas deserving of a multidisciplinary approach, we highlight the need of referring these patients to centers with experts in melanoma, anorectal and uro-genital cancers treatments. Taking into account the rarity, the poor outcomes and the lack of effective treatment options for MM, tailored research needs to be promptly promoted.
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13
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Hassan M, Husain M, Rashid T, Ahmad M. Anorectal malignant amelanotic melanoma: Report of a rare aggressive primary tumor. J Cancer Res Ther 2022; 18:249-252. [DOI: 10.4103/jcrt.jcrt_461_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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14
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Wong DL, Glazer ES, Tsao M, Deneve JL, Fleming MD, Shibata D. Impact of adjuvant therapies following surgery for anal melanoma. Am J Surg 2021; 223:1132-1143. [PMID: 34801225 DOI: 10.1016/j.amjsurg.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anal melanoma is rare. Surgery is standard of care for non-metastatic disease. There are limited data supporting adjuvant therapy. We sought to examine the impact of adjuvant radiation, chemotherapy and immunotherapy on survival. METHODS The National Cancer Database was queried. Factors associated with overall survival were examined by Kaplan-Meier and Cox proportional hazards analyses. Patients were grouped by treatment regimen. RESULTS 450 patients had complete treatment data: surgery alone (63.8%), surgery + radiation (14.9%), surgery + chemotherapy (7.6%), surgery + immunotherapy (9.6%) and non-surgical treatment (4.2%). Median survival was 27.2 months. Node-positive patients had worse survival than node-negative (22.4 vs. 36.8 months; p = 0.0002). Non-surgical treatment yielded worse survival than any surgery-inclusive regimen (10.4 vs. 27.8 months; p = 0.0002). No adjuvant modality conferred a survival advantage. By multivariate analysis, increasing age (HR/1 year = 1.02, p = 0.012) and node positivity (HR = 2.10, p = 0.0002) negatively impacted survival. CONCLUSION Adjuvant therapy for non-metastatic anal melanoma does not appear to influence survival.
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Affiliation(s)
- Denise L Wong
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., Suite 300, Memphis, TN, 38103, USA
| | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., Suite 300, Memphis, TN, 38103, USA
| | - Miriam Tsao
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., Suite 300, Memphis, TN, 38103, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., Suite 300, Memphis, TN, 38103, USA
| | - Martin D Fleming
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., Suite 300, Memphis, TN, 38103, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., Suite 300, Memphis, TN, 38103, USA.
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15
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Jutten E, Kruijff S, Francken AB, Lutke Holzik MF, van Leeuwen BL, van Westreenen HL, Wevers KP. Surgical treatment of anorectal melanoma: a systematic review and meta-analysis. BJS Open 2021; 5:6446962. [PMID: 34958352 PMCID: PMC8675246 DOI: 10.1093/bjsopen/zrab107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Anorectal melanoma is a rare neoplasm with a poor prognosis. The surgical approaches for anorectal melanoma can be categorized into local excision (procedures without lymph node removal and preservation of the rectum) and extensive resection (procedures with rectum and pararectal lymph node removal). The aim of this systematic review and meta-analysis was to compare the survival of patients who underwent extensive resection with that of patients who underwent local excision, stratifying patients according to tumour stage. Methods A literature review was performed according to PRISMA guidelines by searching MEDLINE/PubMed for manuscripts published until March 2021. Studies comparing survival outcomes in patients with anorectal melanoma who underwent local excision versus extensive resection were screened for eligibility. Meta-analysis was performed for overall survival after the different surgical approaches, stratified by tumour stage. Results There were 347 studiesidentified of which 34 were included for meta-analysis with a total of 1858 patients. There was no significant difference in overall survival between the surgical approaches in patients per stage (stage I odds ratio 1.30 (95 per cent c.i. 0.62 to 2.72, P = 0.49); stage II odds ratio 1.61 (95 per cent c.i. 0.62 to 4.18, P = 0.33); stage I–III odds ratio 1.19 (95 per cent c.i. 0.83 to 1.70, P = 0.35). Subgroup analyses were conducted for the time intervals (<2000, 2001–2010 and 2011–2021) and for continent of study origin. Subgroup analysis for time interval and continent of origin also showed no statistically significant differences in overall survival. Conclusion No significant survival benefit exists for patients with anorectal melanoma treated with local excision or extensive resection, independent of tumour stage.
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Affiliation(s)
- Esther Jutten
- Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands.,Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Anne Brecht Francken
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - Martijn F Lutke Holzik
- Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Henderik L van Westreenen
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.,Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - Kevin P Wevers
- Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
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Bakare AN, Agrawal A, Saklani A, Engineer R, Purandare N, Shah S, Puranik A, Rangarajan V. Diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in anorectal melanoma. World J Nucl Med 2021; 20:215-221. [PMID: 34703388 PMCID: PMC8488889 DOI: 10.4103/wjnm.wjnm_116_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 12/03/2022] Open
Abstract
To evaluate the diagnostic role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in initial staging and restaging of anorectal melanoma. This was a single-institution, retrospective observational study; patients for initial staging and with clinical or radiological suspicion of disease recurrence referred for PET/CT between January 2006 and December 2015 were included in the study. Diagnostic performance of PET/CT was evaluated for baseline staging and disease recurrence. A total of 61 patients who were referred for initial staging were included. PET/CT correctly detected primary lesion in 57 (93.44%) cases, regional nodes in 46 (75.4%) cases, nonregional nodes in 22 (36%) cases, and distant metastases in 25 (41%) cases. The sensitivity (SN); specificity (SP); positive predictive value (PPV); negative predictive value (NPV); and accuracy for primary lesion, regional nodes, nonregional nodes, and distant metastases were 96.6%, 100%, 100%, 50%, and 96.7%; 97.9%, 100%, 100%, 93.3%, and 98.4%; 100%, 100%, 100%, 100%, and 100%; and 100%, 100%, 100%, 100%, and 100%, respectively. A total of 24 patients were included for suspected recurrence/restaging. All the patients were treated previously by surgery, radiotherapy, or chemotherapy. PET/CT detected disease recurrence in 20 (83.3%) patients. Ten patients had recurrence at the primary site, 8 of whom also had distant metastases and 2 had only locoregional metastatic nodes. In the remaining 10 patients, there was no primary site recurrence; however, 2 patients had locoregional nodal and distant metastases and 8 patients had only distant metastases. PET/CT was false negative in 1 patient, which missed liver metastasis. SN, SP, PPV, and NPV of PET/CT was found to be 95%, 100%, 100%, and 75%, respectively, with accuracy of 96%. PET/CT demonstrates overall high diagnostic accuracy in the initial staging and detection of recurrent disease in cases of anorectal melanoma.
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Affiliation(s)
- Ajinkya N Bakare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Singh BK, Ray S, Dhawan S, Nundy S. Spectrum of presentation in primary anorectal malignant melanoma and its management. BMJ Case Rep 2021; 14:e245449. [PMID: 34598968 PMCID: PMC8488700 DOI: 10.1136/bcr-2021-245449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/03/2022] Open
Abstract
The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is to give an overview of the variable presentation of this rare entity from a high-volume colorectal tertiary care centre in a developing country. The patients ranged in age from 55 to 73 years and were mostly women (except one). The clinical presentation varied from bleeding per rectum to tenesmus and mucus in stools, overlapping with those of inflammatory bowel disease and primary anorectal adenocarcinoma. All patients were treated with surgery (laparoscopic or open), ranging from local excision to abdominoperineal resection. All our patients had a good outcome after surgery with no mortality at 30 or 90 days after surgery. The article aims to present a comprehensive overview of the various options of management with evidence from the surgical literature.
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Affiliation(s)
- Barun Kumar Singh
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Samrat Ray
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Pathology/Histopathology Unit, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
Noncutaneous melanomas are rare subtypes of melanoma with high rates of metastatic disease and poor overall survival. One-third to one-half of cases are amelanotic, which may contribute to a delay in diagnosis. Immunohistochemistry staining with typical melanoma markers helps confirm the diagnosis. There is no standard staging system across mucosal melanomas. Elective nodal dissection is not recommended and there is a paucity of data to support use of sentinel lymph node biopsy. Mutational analysis should be routinely performed. Systemic therapy options include targeted inhibitors, immunotherapy, and cytotoxic chemotherapy, although further studies are needed to confirm their efficacy.
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Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA.
| | - Russell S Berman
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA. https://twitter.com/bermar01
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19
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Kottakota V, Warikoo V, Yadav AK, Salunke A, Jain A, Sharma M, Bhatt S, Puj K, Pandya S. Clinical and oncological outcomes of surgery in Anorectal melanoma in Asian population: A 15 year analysis at a tertiary cancer institute. Cancer Treat Res Commun 2021; 28:100415. [PMID: 34119764 DOI: 10.1016/j.ctarc.2021.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Anorectal malignant melanoma (ARMM) is an aggressive malignancy with dismal prognosis and a 5-year survival rate less than 20% in most of the previous studies. The ideal surgical treatment has still remained controversial. This retrospective study aims at analysing the outcome in patients with ARMM treated with curative surgical resection. PATIENTS AND METHODS This is a retrospective study of 38 patients of stage I anorectal malignant melanoma treated with curative surgical resection at our tertiary cancer institute. RESULTS WLE (Wide Local Excision) was carried out in 12 patients and APR (abdominoperineal resection) was done in 26 patients. The median overall survival of the entire group in this study was 20 months. Although the median overall survival of WLE patients was higher than those with APR (37 months versus 16 months, respectively), this was not a statistically significant event (P=0.317). The 1-, 2-, 3-, 5-year survival rates were similar with both APR and WLE with no significant difference in the 5-year survival rate (P=0.816); overall 5-year survival rate of just 13%. There were 3 long-term survivors in this study group who survived for more than 10 years. CONCLUSION Most patients ultimately succumb to the disease regardless of the management. Both APR and WLE have significant roles in the management depending on the subset of patients selected. Local treatment should be preferred wherever possible. Abdominoperineal resection should be offered in nodal disease or in a recurrent setting.
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Affiliation(s)
- Viswanth Kottakota
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India.
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Ajay Kumar Yadav
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Abhijeet Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Abhishek Jain
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Mohit Sharma
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Supreet Bhatt
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Ketul Puj
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Medicity, Asarwa, Ahmedabad, Gujarat, India
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20
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Xu Z, Zhao K, Han L, Li P, Shi Z, Huang X, Han C, Wang H, Chen M, Liu C, Liang Y, Li S, Huang Y, Chen X, Liang C, Cao W, Liu Z. Combining quantitative and qualitative magnetic resonance imaging features to differentiate anorectal malignant melanoma from low rectal cancer. PRECISION CLINICAL MEDICINE 2021; 4:119-128. [PMID: 35694154 PMCID: PMC8982618 DOI: 10.1093/pcmedi/pbab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background Distinguishing anorectal malignant melanoma from low rectal cancer remains challenging because of the overlap of clinical symptoms and imaging findings. We aim to investigate whether combining quantitative and qualitative magnetic resonance imaging (MRI) features could differentiate anorectal malignant melanoma from low rectal cancer. Methods Thirty-seven anorectal malignant melanoma and 98 low rectal cancer patients who underwent pre-operative rectal MRI from three hospitals were retrospectively enrolled. All patients were divided into the primary cohort (N = 84) and validation cohort (N = 51). Quantitative image analysis was performed on T1-weighted (T1WI), T2-weighted (T2WI), and contrast-enhanced T1-weighted imaging (CE-T1WI). The subjective qualitative MRI findings were evaluated by two radiologists in consensus. Multivariable analysis was performed using stepwise logistic regression. The discrimination performance was assessed by the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI). Results The skewness derived from T2WI (T2WI-skewness) showed the best discrimination performance among the entire quantitative image features for differentiating anorectal malignant melanoma from low rectal cancer (primary cohort: AUC = 0.852, 95% CI 0.788-0.916; validation cohort: 0.730, 0.645-0.815). Multivariable analysis indicated that T2WI-skewness and the signal intensity of T1WI were independent factors, and incorporating both factors achieved good discrimination performance in two cohorts (primary cohort: AUC = 0.913, 95% CI 0.868-0.958; validation cohort: 0.902, 0.844-0.960). Conclusions Incorporating T2WI-skewness and the signal intensity of T1WI achieved good performance for differentiating anorectal malignant melanoma from low rectal cancer. The quantitative image analysis helps improve diagnostic accuracy.
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Affiliation(s)
- Zeyan Xu
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Ke Zhao
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Lujun Han
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Pinxiong Li
- Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Zhenwei Shi
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaomei Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Chu Han
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Huihui Wang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Minglei Chen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Chen Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Yanting Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Suyun Li
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yanqi Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou 510180, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wuteng Cao
- Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, China
| | - Zaiyi Liu
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Nagaoka T, Nagasaki T, Akiyoshi T, Mukai T, Yamaguchi T, Shinozaki E, Fukunaga Y. Outcomes of Surgical Treatment for Patients with Anorectal Malignant Melanoma; Results of Nine Cases in a Single Institution. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:192-196. [PMID: 33937561 PMCID: PMC8084533 DOI: 10.23922/jarc.2020-083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
Anorectal melanoma (AM) is a rare and aggressive malignancy. Two main types of surgical approach for AM are abdominoperineal resection (APR) and wide local excision (WLE). Nine patients with AM underwent surgical treatment between July 2005 and October 2017 at our institution. Two of the patients were diagnosed with localized stage, four with regional stage, and three with distant stage. Laparoscopic APR was performed in six patients with localized and regional stages, whereas palliative APR and/or WLE were performed in those with distant metastasis. Both patients with localized stage lived without relapse for 6.8 years after surgery. One of the patients with regional stage had no relapse during 3.6 years of follow-up. The other three patients had recurrence and died between 6 and 32 months after surgery. The median overall survival (OS) of the cohort was 14.8 months, and the 5- and 10-year OS were 33.3% and 16.7%, respectively. The tumor at the regional stage could be removed through WLE, but preoperative diagnosis of lymph node metastasis is difficult in patients with AM. Further development of the diagnostic method is expected, and future tasks will be to establish the selection criteria to determine which surgical approach is optimal for this devastating disease.
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Affiliation(s)
- Tomoyuki Nagaoka
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiki Mukai
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Gastroenterological Center, Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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22
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Kahl AR, Gao X, Chioreso C, Goffredo P, Hassan I, Charlton ME, Lin C. Presentation, Management, and Prognosis of Primary Gastrointestinal Melanoma: A Population-Based Study. J Surg Res 2021; 260:46-55. [PMID: 33316759 PMCID: PMC7946707 DOI: 10.1016/j.jss.2020.11.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/19/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary gastrointestinal (GI) melanomas, compared with cutaneous melanomas, have a much lower incidence. As a result, there is a paucity of data regarding their presentation, treatment, and prognosis. The aim of this study was to analyze the incidence, patient characteristics, treatment patterns, and survival of primary GI melanomas in comparison with cutaneous melanomas using a population-based cohort. METHODS Patients diagnosed with primary GI and cutaneous melanomas were identified from Surveillance, Epidemiology, and End Results 1973-2016 data. RESULTS A total of 872 primary GI melanomas and 319,327 cutaneous melanomas were identified. GI melanoma incidence increased by an annual percent change of 1.82 (P < 0.05) during the study period. The most common sites for GI melanoma were the anus (50%) and rectum (34%). Compared to cutaneous melanoma, patients diagnosed with GI melanomas were older, women (58% versus 45%), non-White (16% versus 6%), and presented with a higher stage (36% versus 4% distant stage, all P < 0.001). GI melanomas had significantly worse cancer-specific survival (CSS) than cutaneous melanoma. Despite the poor prognosis, the CSS has increased in recent years. Among patients with anorectal melanomas, local excision with chemotherapy and/or radiation had a similar CSS compared with those with major surgery only. CONCLUSIONS Despite a steady increasing incidence since 1975, GI melanomas are rare, present with advanced stages, and have worse outcomes than cutaneous melanomas. The improved prognosis of these tumors in recent years might reflect the impact of novel targeted treatments and the more common use of local tumor excision over major resections.
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Affiliation(s)
| | - Xiang Gao
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Catherine Chioreso
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Paolo Goffredo
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Imran Hassan
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Chi Lin
- University of Nebraska Medical Center
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Bleicher J, Cohan JN, Huang LC, Peche W, Pickron TB, Scaife CL, Bowles TL, Hyngstrom JR, Asare EA. Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature. World J Gastroenterol 2021; 27:267-280. [PMID: 33519141 PMCID: PMC7814367 DOI: 10.3748/wjg.v27.i3.267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anorectal melanoma (ARM) is a rare disease with a poor prognosis. Evidence on optimal treatment is limited and surgical management varies widely. We hypothesized that the frequency of abdominoperineal resection used as primary treatment of ARM has decreased over the past several decades.
AIM To update our understanding of outcomes for patients with ARM and analyze management trends around the world.
METHODS This is a multi-institutional, retrospective study of patients treated for ARM at 7 hospitals. Hospitals included both large, academic, tertiary care centers and smaller, general community hospitals. Using prospectively maintained institutional tumor registries, we identified 24 patients diagnosed with ARM between January 2000 and May 2019. We analyzed factors prognostic for recurrence and survival. We then used Cox regression to measure overall survival (OS) and melanoma-specific survival. We also performed a literature review to assess trends in surgical management and outcomes.
RESULTS Of the 24 patients diagnosed with ARM, 12 (50.0%) had local, 8 (33.3%) regional, and 4 (16.7%) distant disease at diagnosis. Median time to recurrence was 10.4 mo [interquartile range (IQR) 7.5-17.2] with only 2 patients (9.3%) not developing recurrence following surgical resection. Median OS was 18.8 mo (IQR 13.5-33.9). One patient is still alive without recurrence at 21.4 mo from diagnosis; no other patient survived 5 years. Primary surgical management with abdominoperineal resection (APR) vs wide excision (WE) did not lead to differences in OS [hazard ratio = 1.4 (95%CI: 0.3-6.8)]. Review of the literature revealed geographic differences in surgical management of ARM, with increased use of WE in the United States and Europe over time and more frequent use of APR in Asia and India. There was no significant improvement in survival over time.
CONCLUSION There is wide variation in the management of ARM and survival outcomes remain poor regardless of approach. Surgical management should aim to minimize morbidity.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Jessica N Cohan
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Lyen C Huang
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - William Peche
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84114, United States
| | - T Bartley Pickron
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Courtney L Scaife
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
| | - Tawnya L Bowles
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, Intermountain Medical Center, Murray, UT 84107, United States
| | - John R Hyngstrom
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84114, United States
| | - Elliot A Asare
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
- Department of Surgery, Intermountain Medical Center, Murray, UT 84107, United States
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Nonaka K, Kudou K, Sasaki S, Jogo T, Hirose K, Kasagi Y, Hu Q, Tsuda Y, Hisamatsu Y, Ando K, Nakashima Y, Saeki H, Oki E, Kamori M, Mori M. Primary anorectal malignant melanoma with laparoscopic abdominoperineal resection: a case study and review of the relevant literature. Int Cancer Conf J 2020; 9:116-122. [PMID: 32582514 PMCID: PMC7297936 DOI: 10.1007/s13691-020-00401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 02/13/2020] [Indexed: 12/18/2022] Open
Abstract
ARMM is a disease with a poor prognosis. ARMM is often diagnosed at an advanced stage, and the 5-year survival rate of ARMM is < 20%. Although the number of case reports on ARMM is gradually increasing, the optimal treatment strategy for ARMM remains controversial. We report the case of an 81-year-old woman who had experienced bloody stool for 6 months before her diagnosis and who had been initially diagnosed with hemorrhoids. The pathological diagnosis of a biopsy specimen was malignant melanoma. Other examinations showed no evidence of lymph node or distant metastasis. Based on these results, laparoscopic abdominoperineal resection was performed. Three months later on her first follow-up examination, distant metastasis to the lung and liver was detected. Immunotherapy using Nivolumab was initiated to treat the recurrent disease. We reviewed the characteristics of a total of 1834 ARMM patients described in previous reports on ARMM for which the full text was available on PubMed. We experienced a case of ARMM. The prognosis of ARMM is still poor, regardless of the surgical procedure. Previous studies and our case report suggest that systemic therapy, such as immunotherapy using an anti-PD-1 ligand may be more important than reinforcement of local control for improving the prognosis of ARMM patients.
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Affiliation(s)
- Kentaro Nonaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kensuke Kudou
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Endoscopy and Endoscopic Surgery, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, Fukuoka 814-0193 Japan
| | - Shun Sasaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Jogo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Hirose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Kasagi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Qingjiang Hu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuo Tsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Hisamatsu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuo Kamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Kamori Clinic, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Smith HG, Glen J, Turnbull N, Peach H, Board R, Payne M, Gore M, Nugent K, Smith MJF. Less is more: A systematic review and meta-analysis of the outcomes of radical versus conservative primary resection in anorectal melanoma. Eur J Cancer 2020; 135:113-120. [PMID: 32563895 DOI: 10.1016/j.ejca.2020.04.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Anorectal melanoma (ARM) is a rare disease with a poor prognosis. There is no consensus as to the optimal primary surgical treatment for ARM, with advocates for both radical (abdominoperineal resection [APR]) and conservative strategies (wide local excision [WLE]). Here, we report a systematic review of studies comparing outcomes between these strategies. METHODS Studies comparing APR with WLE in patients with ARM were included, and a systematic review using the Grading of Recommendations, Assessment, Development and Evaluation methodology was performed. Outcomes deemed critical included overall survival, disease-free survival, local recurrence and quality of life. RESULTS Forty studies were identified, of which 27 were suitable for inclusion. Twenty-three studies compared overall survival between WLE and APR, with no difference in outcomes noted (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.60-1.07, p = 0.13). Seven studies compared disease-free survival, with no difference in outcomes noted (RR: 1.08, 95% CI: 0.61-1.91, p = 0.79). A total of 19 studies compared local recurrence rates, with again no significant difference in outcomes noted (RR: 0.71, 95% CI: 0.44-1.14, p = 0.16). None of the studies identified reported quality of life-related outcomes. CONCLUSION There is no evidence to suggest that a radical primary surgical strategy improves outcomes in ARM. Therefore, given the well-documented morbidity associated with APR, WLE with regular surveillance for local recurrence should be the primary strategy in most patients.
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Affiliation(s)
- Henry G Smith
- The Skin Unit, The Royal Marsden Hospital NHS Foundation Trust, London, England, UK; Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Glen
- National Guideline Centre, Royal College of Physicians, London, England, UK; The Health Research Council of New Zealand, Auckland, New Zealand
| | | | - Howard Peach
- Leeds Teaching Hospitals NHS Foundation Trust, UK
| | - Ruth Board
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Miranda Payne
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Martin Gore
- The Skin Unit, The Royal Marsden Hospital NHS Foundation Trust, London, England, UK
| | - Karen Nugent
- University Hospital Southampton NHS Foundation Trust, UK
| | - Myles J F Smith
- The Skin Unit, The Royal Marsden Hospital NHS Foundation Trust, London, England, UK.
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Lian J, Xu A, Chu Y, Chen T, Xu M. Early primary anorectal malignant melanoma treated with endoscopic submucosal dissection: a case report. Int J Colorectal Dis 2020; 35:959-961. [PMID: 32124048 DOI: 10.1007/s00384-020-03546-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anorectal malignant melanoma (ARMM) is a rare disease accounting for less than 1% of primary anorectal malignancies. Here we first present a case of early primary anorectal malignant melanoma completely resected by endoscopic submucosal dissection (ESD). METHODS AND RESULTS A 43-year-old woman visited our hospital because of suspected anal melanoma found by routine colonoscopy in her local hospital. Following series of tests including CT, MRI, and whole-body PET-CT did not show any evidence of metastasis. The lesion was removed by the method of ESD in en bloc and no delayed bleeding or perforation occurred. The result of histopathologic examinations confirmed to be malignant melanoma. No recurrence or distant metastases were found during follow-up time (the latest follow-up was 2 years after ESD). CONCLUSION The present case showed endoscopic submucosal dissection that can be an effective and safe alternative treating early primary anorectal malignant melanoma.
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Affiliation(s)
- Jingjing Lian
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Aiping Xu
- Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Yuan Chu
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Tao Chen
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Meidong Xu
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China.
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27
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Li Z, Šandera P, Beer M, Weber M. A rare case of recurrent primary anorectal melanoma emphasizing the importance of postoperative follow-ups. BMC Surg 2020; 20:68. [PMID: 32264858 PMCID: PMC7140585 DOI: 10.1186/s12893-020-00727-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary anorectal melanoma can be a rare differential diagnosis of anorectal mass. Due to the low case number reported in the literature, physicians are not aware of this aggressive disease. Although no consensus exists, wide local excision and abdominoperineal resection are considered the mainstay therapy. CASE PRESENTATION An 85-year-old female patient presented with fecal incontinence 5 years after local resection of a primary anorectal melanoma. In the rectoscopy, a tumor proximal to the dentate line was identified and later confirmed as a recurrent primary anorectal melanoma. There were no signs of locoregional or distant metastasis on the MRI and PET/CT. She underwent another wide local excision and regained fecal continence postoperatively. CONCLUSIONS Primary anorectal melanoma should belong to the differential diagnosis of anorectal mass. If technically feasible, wide local excision represents a less invasive treatment than abdominoperineal resection, retaining the anal sphincter and patient's quality of life. Even though wide local excision has a higher recurrence rate than abdominoperineal resection, there is no difference in survival between the two procedures. This is only under the premise that patients are followed-up regularly after wide local excision so that recurrence can be spotted early on and locally excised.
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Affiliation(s)
- Zhihao Li
- Department of Visceral, Thoracic, Vascular Surgery, Municipal Hospital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland.
| | - Peter Šandera
- Department of Visceral, Thoracic, Vascular Surgery, Municipal Hospital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Marc Beer
- Department of Pathology, Municipal Hospital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Markus Weber
- Department of Visceral, Thoracic, Vascular Surgery, Municipal Hospital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
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Prognostic model for patient survival in primary anorectal mucosal melanoma: stage at presentation determines relevance of histopathologic features. Mod Pathol 2020; 33:496-513. [PMID: 31383963 DOI: 10.1038/s41379-019-0340-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 02/03/2023]
Abstract
Pathological staging of primary anorectal mucosal melanoma is often performed according to the American Joint Commission on Cancer (AJCC) guidelines for cutaneous melanoma, as an anorectal melanoma-specific staging system does not exist. However, it remains unknown whether prognostic factors derived for cutaneous melanoma also stratify risk in anorectal melanoma. We retrospectively determined correlations between clinicopathological parameters and disease-specific survival in 160 patients. Patients were grouped by clinical stage at presentation (localized disease, regional or distant metastases). Cox proportional hazards regression models determined associations with disease-specific survival. We also summarized the somatic mutations identified in a subset of tumors analyzed for hotspot mutations in cancer-associated gene panels. Most of the patients were white (82%) and female (61%). The median age was 62 years. With a median follow-up of 1.63 years, median disease-specific survival was 1.75 years, and 121 patients (76%) died of anorectal melanoma. Patients presenting with regional (34%) or distant metastases (24%) had significantly shorter disease-specific survival compared to those with disease localized to the anorectum (42%). Of the 71 anorectal melanoma tumors analyzed for hotspot genetic alterations, somatic mutations involving the KIT gene (24%) were most common followed by NRAS (19%). Increasing primary tumor thickness, lymphovascular invasion, and absence of regression also correlated with shorter disease-specific survival. Primary tumor parameters correlated with shorter disease-specific survival in patients presenting with localized disease (tumor thickness) or regional metastases (tumor thickness, absence of regression, and lymphovascular invasion), but not in patients presenting with distant metastases. Grouping of patients according to a schema based on modifications of the 8th edition AJCC cutaneous melanoma staging system stratified survival in anorectal melanoma. Our findings support stage-specific associations between primary tumor parameters and disease-specific survival in anorectal melanoma. Moreover, the AJCC cutaneous melanoma staging system and minor modifications of it predicted survival among anorectal melanoma patients.
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29
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Yen YA, Wu LC, Lu NM, Lee CH. Pigmented villous nodular synovitis mimicking metastases on 18F-FDG PET/CT in a patient with rectal mucosal melanoma: a case report. BMC Musculoskelet Disord 2020; 21:13. [PMID: 31914975 PMCID: PMC6950986 DOI: 10.1186/s12891-019-3034-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mucosal melanomas are rare and have a high potential for metastasizing. Surgical resection is the treatment of choice for single distant metastases. Malignant melanoma usually shows the highest uptake of fluorine-18 fluorodeoxyglucose (18F-FDG). 18F- FDG positron emission tomography /computed tomography (PET/CT) is usually used for melanoma staging. An extensive literature review revealed only 4 published case reports and an original paper involving 8 cases (12 cases in total) of patients with skin melanomas in whom pigmented villous nodular synovitis (PVNS) mimicked metastatic melanoma, however, none of the melanomas reported were of rectal mucosal origin. CASE PRESENTATION A 60-year-old woman presented with recent diagnosis of rectal mucosal melanoma, two additional 18F-FDG-avid lesions in the left ankle and left foot were detected on 18F-FDG PET/CT. Metastases were initially suspected; however, the final diagnosis was PVNS. CONCLUSIONS This is the first report of PVNS mimicking metastases on 18F-FDG PET/CT in a patient with rectal mucosal melanoma. Although high 18F-FDG-avid lesions in patients with rectal mucosal melanoma are highly suspected to be metastasis and warrant an meticulous examination, the present case is a reminder that in such patients, not all lesions with high 18F-FDG uptake, especially those near a joint, are metastases and that more extensive resection is unnecessary.
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Affiliation(s)
- Yu-An Yen
- Department of Nuclear Medicine, Chi Mei Medical Center, 901, Zhonghua Rd., Yongkang Dist, Tainan City, 710, Taiwan
| | - Li-Chun Wu
- Department of Nuclear Medicine, Chi Mei Medical Center, 901, Zhonghua Rd., Yongkang Dist, Tainan City, 710, Taiwan
| | - Na-Mi Lu
- Department of Pathology, Liouying Chi Mei Hospital, Tainan, Taiwan
| | - Chiang Hsuan Lee
- Department of Nuclear Medicine, Chi Mei Medical Center, 901, Zhonghua Rd., Yongkang Dist, Tainan City, 710, Taiwan.
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30
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Abuoğlu HH, Gençtürk M, Yıldız MK, İlhan O, Gülmez M, Kaytaz K, Özkara S. Anorectal Malignant Melanoma: Case Report And Treatment Options. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.641952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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31
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Treatment Strategies and Survival Trends for Anorectal Melanoma: Is it Time for a Change? World J Surg 2019; 43:1809-1819. [PMID: 30830243 DOI: 10.1007/s00268-019-04960-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM. METHODS Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed. RESULTS A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type. CONCLUSION The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.
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32
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Schmidt H, Connolly C, Jaffer S, Oza T, Weltz CR, Port ER, Corben A. Evaluation of surgically excised breast tissue microstructure using wide-field optical coherence tomography. Breast J 2019; 26:917-923. [PMID: 31612563 DOI: 10.1111/tbj.13663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, positive margins at lumpectomy contribute to health care cost, patient anxiety, and treatment delay. Multiple technology solutions are being explored with the aim of lowering re-excision rates for breast-conserving surgery (BCS). We examined wide-field optical coherence tomography (WF-OCT), an innovative adjunct intraoperative imaging tool for tissue visualization of margins. METHODS This IRB-approved pilot study included women with invasive or in situ carcinoma scheduled for primary BCS. Lumpectomy specimens and any final/revised margins were imaged by optical coherence tomography immediately prior to standard histological processing. The optical coherence tomography used provided two-dimensional, cross-sectional, real-time depth visualization of the margin widths around excised specimens. A volume of images was captured for 10 × 10 cm tissue surface at high resolution (sub-30 μm) to a depth of 2 mm. Integrated interpretation was performed incorporating final pathology linked with the optical image data for correlation. RESULTS Wide-field optical coherence tomography was performed on 185 tissue samples (50 lumpectomy specimens and 135 additional margin shaves) in 50 subjects. Initial diagnosis was invasive ductal carcinoma (IDC) in 10, ductal carcinoma in situ (DCIS) in 14, IDC/DCIS in 22, invasive lobular carcinoma (ILC) in 2, ILC/DCIS in 1, and sarcoma in 1. Optical coherence tomography was concordant with final pathology in 178/185 tissue samples for overall accuracy of 86% and 96.2% (main specimen alone and main specimen + shave margins). Of seven samples that were discordant, 57% (4/7) were considered close (DCIS < 2 mm from margin) per final pathology. CONCLUSION Wide-field optical coherence tomography demonstrated concordance with histology at tissue margins, supporting its potential for use as a real-time adjunct intraoperative imaging tool for margin assessment. Further studies are needed for comprehensive evaluation in the intraoperative setting.
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Affiliation(s)
- Hank Schmidt
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Courtney Connolly
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Shabnam Jaffer
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Twisha Oza
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Christina R Weltz
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Elisa R Port
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Adriana Corben
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
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Hashida H, Kondo M, Yamashita D, Hara S, Mizuno R, Mizumoto M, Kobayashi H, Kaihara S. Transperineal abdominoperineal resection for anorectal melanoma: A case report. Int J Surg Case Rep 2019; 61:214-217. [PMID: 31377547 PMCID: PMC6698315 DOI: 10.1016/j.ijscr.2019.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/18/2019] [Indexed: 01/29/2023] Open
Abstract
Anorectal malignant melanoma is rare and prone to metastasis. An anorectal melanoma was resected via transperineal abdominoperineal resection (TpAPR). The patient remained disease-free until the 24-month follow-up. TpAPR/total mesorectal excision (TME) for anorectal melanoma appears to be a feasible approach.
Introduction Anorectal melanoma is a rare type of cancer characterized by frequent metastasis. We report our experience with a case of anorectal melanoma resected via transperineal abdominoperineal resection and total mesorectal excision. Presentation of case A 77-year-old woman visited our hospital with the complaint of melena. Colonoscopic examination revealed a black type 1 tumor measuring 5 mm in size on the dentate line of the anal canal circumference. Tumor biopsy revealed malignant melanoma, and positron emission tomography-computed tomography showed tracer accumulation within the mass but not at other sites. We performed a two-stage abdominoperineal resection surgery with lymphadenectomy via transperineal abdominoperineal resection, and pathological diagnosis indicated submucosal tumor depth. The patient was diagnosed with T2 N0 M0 stage I malignant melanoma and was followed on an outpatient basis. A 24-month follow-up computed tomography revealed multiple liver metastases. Discussion Anorectal melanoma is associated with a very poor prognosis because of its association with early lymph node metastasis and distant metastasis. The tumor may spread beyond the main lesion and involve the surrounding mucosa and draining lymph nodes. Transperineal abdominoperineal resection is a minimally invasive procedure that can be used to achieve curative tumor resection with lymphadenectomy. Conclusion Transperineal abdominoperineal resection appears to be a feasible approach for the treatment of anorectal melanoma.
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Affiliation(s)
- Hiroki Hashida
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Daisuke Yamashita
- Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryosuke Mizuno
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Motoko Mizumoto
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Naqvi J, Lee A, Lederman A, Kavi A, Osborn VW, Schreiber D. Patterns of Care and Survival Outcomes in the Treatment of Anal Melanoma. J Gastrointest Cancer 2019; 51:211-216. [PMID: 30982929 DOI: 10.1007/s12029-019-00238-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Anal mucosal melanoma is an uncommon malignancy of the anal canal, with few large studies available to establish clear trends in the treatment modalities presently available. The primary goal of this study was to identify the patterns of care in the treatment of anal melanoma and secondarily to determine outcomes. METHODS This was a retrospective study performed utilizing the National Cancer Database (NCDB). A total of 787 patients diagnosed with anal melanoma between 2004 and 2014 were selected, of which 398 had staging information. The four treatment groups analyzed were surgical excision alone, surgical excision and radiation therapy, surgical excision and immunotherapy/chemotherapy, and radiation therapy plus minus immunotherapy/chemotherapy. Treatment was grouped by extent of disease; the Kaplan-Meier method was used to analyze overall survival and multivariate Cox proportional model was used to identify factors associated with overall survival. RESULTS The majority of patients presented with either node-positive (39.4%) or metastatic disease (37.4%). Patients with surgical excision and radiation therapy had the highest median survival at 32.3 months. This is in contrast with those receiving surgical excision alone (22.9 months), surgery and immunotherapy/chemotherapy (18.4 months), and radiation without surgery (5.1 months) (p < 0.0001). CONCLUSIONS Treatment with surgical excision was the most common initial treatment with no single modality superior over another in this rare entity.
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Affiliation(s)
- Jaffer Naqvi
- Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY, 11203, USA
| | - Anna Lee
- Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY, 11203, USA.
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.
| | - Ariel Lederman
- Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY, 11203, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Ami Kavi
- Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY, 11203, USA
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Virginia W Osborn
- Department of Radiation Oncology, Elmhurst Hospital Center, Queens, NY, USA
| | - David Schreiber
- Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY, 11203, USA
- Summit Medical Group, Berkeley Heights, NJ, USA
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Primary anorectal melanoma: clinical, immunohistology and DNA analysis of 43 cases. Pathology 2018; 51:39-45. [PMID: 30497801 DOI: 10.1016/j.pathol.2018.09.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/30/2018] [Accepted: 09/09/2018] [Indexed: 12/31/2022]
Abstract
Primary melanoma involving the anorectal region is rare, accounting for <1% of all melanomas in most Western countries. It characteristically presents at an advanced clinical stage and is associated with poor clinical outcomes. Preliminary reports suggest that response rates to immunotherapies in patients with advanced stage mucosal melanoma are much lower than in cutaneous (or acral) melanoma patients but reasons for this are unclear. Comprehensive characterisation of the immune microenvironment in anorectal melanoma has not previously been performed. A single-institution cohort of 43 primary anorectal melanoma patients was examined to describe clinicopathological features and characterise the immune microenvironment to provide insights into the behaviour of this rare melanoma subtype. The tumours displayed multiple adverse prognostic attributes including deep thickness (median 11.5 mm), ulceration (81%) and high mitotic rate (median 12/mm2). The median overall survival was 24 months and the median recurrence-free survival was 9 months. Tumour-infiltrating lymphocytes (TILs) were absent or mild in most tumours (75%); PD-L1 positive staining (>1% of tumour cells) was present in 44% of cases, however in 86% of positive tumours the percentage of positive cells was ≤10%. Four tumours underwent whole genome sequencing; no ultraviolet signature was identified, and there was a lower mutational load but higher structural chromosomal variant load compared with cutaneous melanomas. Poor responses of anorectal melanomas to immunotherapy may be caused by lower immunogenicity of these tumours as characterised by low mutation burden (and therefore low neoantigenicity), low TILs infiltrates and low PD-L1 expression. Further investigation is required to determine whether TILs and PD-L1 expression predict response to immunotherapy in patients with mucosal melanoma.
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Atak I. Anorectal Malignant Melanoma: Retrospective Analysis of Six Patients and Review of the Literature. Prague Med Rep 2018; 119:97-106. [DOI: 10.14712/23362936.2018.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Malignant melanomas are rare aggressive tumours originating from the pigment-producing melanocytes. In our study, a review of the literature and a retrospective analysis of patients undergoing surgery at our clinic due to anorectal malignant melanoma were performed. The information of 6 patients undergoing surgery in our clinic due to anorectal malignant melanoma between January 2010 and January 2018 was retrieved retrospectively. The patients were assessed regarding demographic data, physical examination and imaging findings, the surgical method performed, postoperative complication, histopathological findings, oncological treatment and follow-up results. Four of the patients were female and 2 were male and the mean age was 61.6 (46–83) years. Two patients (33%) had liver metastases at the time of initial presentation. Abdominoperineal resection (APR) was performed in all patients 3 with laparoscopic method. The mean length of hospital stay was recorded to be 6.5 ± 1 days (5–12 days). Adjuvant chemotherapy and radiotherapy were administered in all patients. Also, interferon treatment was administered in one patient additionally. During the follow-up, 4 patients died due to extensive metastatic disease determined approximately in the 13th month. Two patients with regular follow-up are well and free of disease and their mean postoperative lifetime has been determined to be 12.5 months (6–26 months). Anorectal malignant melanomas (ARMM) are rare but aggressive tumours. The treatment should be focused on minimizing morbidity and maximizing the quality of life and function while removing the gross tumour.
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Fields AC, Goldberg J, Senturk J, Saadat LV, Jolissaint J, Shabat G, Irani J, Bleday R, Melnitchouk N. Contemporary Surgical Management and Outcomes for Anal Melanoma: A National Cancer Database Analysis. Ann Surg Oncol 2018; 25:3883-3888. [DOI: 10.1245/s10434-018-6769-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Indexed: 12/29/2022]
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Ren M, Lu Y, Lv J, Shen X, Kong J, Dai B, Kong Y. Prognostic factors in primary anorectal melanoma: a clinicopathological study of 60 cases in China. Hum Pathol 2018; 79:77-85. [PMID: 29763716 DOI: 10.1016/j.humpath.2018.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 12/13/2022]
Abstract
To investigate the clinicopathological features and prognostic factors of primary anorectal melanoma, we described the clinical presentations, histopathology, and prognosis of 60 cases in China. Patients' age ranged from 17 to 86 years, with a female-to-male ratio of 2.33:1. The prevalent anatomic site of tumor was the anorectum. The mean tumor thickness was 11.5 mm, and mean tumor size was 2.9 cm. Abdominoperineal resection was performed on 38 (63.3%) patients, whereas wide local excision was performed on 22 (36.7%) patients. Thirty-three (55.0%) patients were pathologically confirmed to have lymph node metastasis, and 9 (15%) patients had clinically distant metastasis at diagnosis. Histologically, epithelioid cell (91.7%) was the predominant cell type, followed by spindle (31.7%), pleomorphic (25.0%), and small round cell (5.0%). Solid sheet, nest, pseudopapillary, and pseudoalveolar growth patterns were noted in 45 (75.0%), 22 (36.7%), 13 (21.7%), and 6 (10.0%) cases, respectively. After a median follow-up of 44 months, the 5-year disease-specific survival rate was 33.3%. Age, tumor size, depth of invasion, tumor thickness, lymphatic metastasis, and lymphovascular and perineural invasion were significantly correlated with survival in univariate analysis. Multivariate analysis revealed that age greater than 70 years and tumor invasion beyond deep muscular layer/sphincter ani externus were independent poor prognostic factors. As the largest single-institution study of anorectal melanoma in an Asian population, we concluded that anorectal melanoma is a rare and lethal malignant neoplasm with morphologic diversity. Large population-based studies are still needed to establish an efficient staging system in evaluation of prognosis and facilitation of treatment for anorectal melanoma patients.
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Affiliation(s)
- Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yawen Lu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiaojie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xuxia Shen
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jincheng Kong
- Department of Pathology, First People's Hospital, Shanghai Jiaotong University, Shanghai 200032, China
| | - Bo Dai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Yunyi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Ha R, Friedlander LC, Hibshoosh H, Hendon C, Feldman S, Ahn S, Schmidt H, Akens MK, Fitzmaurice M, Wilson BC, Mango VL. Optical Coherence Tomography: A Novel Imaging Method for Post-lumpectomy Breast Margin Assessment-A Multi-reader Study. Acad Radiol 2018; 25:279-287. [PMID: 29174226 DOI: 10.1016/j.acra.2017.09.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/12/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to assess whether different breast cancer subspecialty physicians can be trained to distinguish non-suspicious from suspicious areas of post-lumpectomy specimen margin in patients with breast cancer using optical coherence tomography (OCT) images (a near-infrared based imaging technique) with final histology as the reference standard. MATERIALS AND METHODS This institutional review board-exempt, Health Insurance Portability and Accountability Act-compliant study was performed on 63 surgically excised breast specimens from 35 female patients, creating a 90-case atlas containing both non-suspicious and suspicious areas for cancer. OCT images of the specimens were performed, providing 6.5-15 µm resolution with tissue visualization 1-2 mm subsurface. From the 90-case atlas, 40 cases were chosen for training and 40 were randomly selected for reader assessment. Three breast imaging radiologists, two pathologists, two breast surgeons, and one non-clinical reader were trained and assessed for ability to distinguish non-suspicious from suspicious findings blinded to clinical data and corresponding histology slides. Duration of training and assessment, sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve for each reader were calculated as well as averages by subspecialty. RESULTS The average training time was 3.4 hours (standard deviation, 1.2). The average assessment time was 1.9 hours (standard deviation, 0.7). The overall average reader sensitivity, specificity, and accuracy for detecting suspicious findings with histologic confirmation of cancer at the surgical margin for all eight readers were 80%, 87%, and 87%, respectively. Radiologists demonstrated the highest average among the disciplines, 85%, 93%, and 94%, followed by pathologists, 79%, 90%, and 84%, and surgeons, 76%, 84%, and 82% respectively. CONCLUSIONS With relatively short training (3.4 hours), readers from different medical specialties were able to distinguish suspicious from non-suspicious OCT imaging findings in ex vivo breast tissue as confirmed by histology. These results support the potential of OCT as a real-time intraoperative tool for post-lumpectomy specimen margin assessment.
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Affiliation(s)
- Richard Ha
- Columbia University Medical Center, New York, New York.
| | | | | | | | | | - Soojin Ahn
- Mount Sinai, New Icahn School of Medicine, New York, New York
| | - Hank Schmidt
- Mount Sinai, New Icahn School of Medicine, New York, New York
| | - Margaret K Akens
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | | | - Brian C Wilson
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
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Ranjith S, Muralee M, Sajeed A, Arun PM, Cherian K, Nair CK, Augustine P, Ahamed I. Anorectal melanoma: experience from a tertiary cancer care centre in South India. Ann R Coll Surg Engl 2018; 100:185-189. [PMID: 29046101 PMCID: PMC5930086 DOI: 10.1308/rcsann.2017.0184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- S Ranjith
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - M Muralee
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - A Sajeed
- Division of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - PM Arun
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - K Cherian
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - CK Nair
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - P Augustine
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - I Ahamed
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
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Ohta R, Inoue T, Goto M, Tachimori Y, Sekikawa K. Combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma: A case report. Int J Surg Case Rep 2018; 44:135-138. [PMID: 29501018 PMCID: PMC5910508 DOI: 10.1016/j.ijscr.2018.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/21/2018] [Accepted: 02/17/2018] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION This report presents a case of anorectal malignant melanoma treated with combined laparoscopic abdomino-endoscopic perineal total mesorectal excision. PRESENTATION OF CASE An 82-year-old female presented with hematochezia. Colonoscopy revealed a 5-cm tumor in the anorectal junction, and biopsy specimen showed malignant melanoma. Modified ransanal total mesorectal excision was performed to get the sufficient surgical resection margins. After lymph node dissection in usual manner, mobilizing the rectum to the level of levator ani muscle. Then a skin incision was made around the anus and the transperineal access platform was placed. The fat tissue of the ischioanal fossa was divided until the levator ani muscle was exposed. The oral side of the colon was transected and specimen was extracted through the perineal incision site. Then stoma was placed laparoscopically. DISCUSSION This procedure provides not only better exposure of the extralevator surgical field, but also efficient resection margins compared with the conventional andominoperineal resection. CONCLUSION To the best of our knowledge, this is the first report of combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma. Our experience showed safety and feasible option for anorectal malignant diseases.
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Affiliation(s)
- Ryo Ohta
- Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan.
| | - Takahiro Inoue
- Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Manabu Goto
- Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yuji Tachimori
- Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Koji Sekikawa
- Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Abstract
BACKGROUND Anorectal malignant melanoma is a rare tumor with a poor prognosis. Typical symptoms (bleeding, pain, perianal mass) are characteristic of hemorrhoids. This, together with the high rate of amelanotic tumors, often delays diagnosis. No therapy guidelines exist. MATERIALS AND METHODS Based on our own experience of surgically treated patients and an extensive literature search, we present a stage-dependent therapeutic concept. RESULTS Eight patients (six women) with a mean age of 65 ± 8 years were treated at our institution. Six underwent abdominoperineal resection; two had local excision. Two patients additionally underwent inguinal lymph node dissection. Median survival was 12 months with a disease-free survival of 6 months. Forty treatment studies with a total of 1,970 cases could be identified. Prognostic factors are age, time to correct diagnosis, tumor extent, tumor stage, and perineural invasion. The impact of lymph node metastases and R0 resection varies. Surgery is the only effective therapy. Local excision is sufficient when free resection margins are achieved. CONCLUSIONS Locally limited tumors should be resected; if possible using local excision. Larger tumors or tumors with sphincter infiltration often require abdominoperineal resection with curative intent. When regional lymph node metastases are present, we advise regional lymphadenectomy of the affected area. In the case of distant metastases, palliative surgery is needed for metastasectomy and in cases of incontinence or refractory pain.
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Malaguarnera G, Madeddu R, Catania VE, Bertino G, Morelli L, Perrotta RE, Drago F, Malaguarnera M, Latteri S. Anorectal mucosal melanoma. Oncotarget 2018; 9:8785-8800. [PMID: 29492238 PMCID: PMC5823579 DOI: 10.18632/oncotarget.23835] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/26/2017] [Indexed: 02/05/2023] Open
Abstract
Anorectal melanoma is an uncommon and aggressive mucosal melanocytic malignancy. Due to its rarity, the pre-operative diagnosis remains difficult. The first symptoms are non-specific such as anal bleeding, anal mass or pain. Although anorectal melanoma carries a poor prognosis; optimal therapeutics strategies are unclear. Surgical resection remains the mainstay of treatment. The optimal surgical procedure for primary tumours is controversial and can vary from wide local excision or endoscopic mucosal resection (EMR) to an abdomino-perineal resection. A high degree of uncertainly exists regarding the benefit of radiation therapy or chemotherapy. The treatment of advanced melanoma is evolving rapidly with better understanding of the disease biology and immunology. Considerable effort has been devoted to the identification of molecular determinants of response to target therapies and immunotherapy.
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Affiliation(s)
- Giulia Malaguarnera
- Research Center "The Great Senescence", University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Roberto Madeddu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Vito Emanuele Catania
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Gaetano Bertino
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - Luca Morelli
- Department of Surgery, University of Pisa, Pisa, Italy
| | - Rosario Emanuele Perrotta
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Michele Malaguarnera
- Research Center "The Great Senescence", University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Saverio Latteri
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
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Ologun GO, Stevenson Y, Shen A, Rana NK, Hussain A, Bertsch D, Cagir B. Anal Melanoma in an Elderly Woman Masquerading as Hemorrhoid. Cureus 2017; 9:e1880. [PMID: 29387509 PMCID: PMC5786347 DOI: 10.7759/cureus.1880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Anal melanoma is a rare and aggressive neoplasm of the anal canal seen in the elderly population in the six or seventh decade of their lives. Presentation is usually nonspecific and diagnosis is often delayed or missed initially. The management is surgical and prognosis is poor. Here we present a case of anal melanoma in an elderly patient masquerading as hemorrhoid.
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Affiliation(s)
| | | | - Alice Shen
- General Surgery, Robert Packer Hospital/Guthrie Clinic
| | | | - Amber Hussain
- General Surgery, Robert Packer Hospital/Guthrie Clinic
| | - David Bertsch
- Surgical Oncology, Robert Packer Hospital/Guthrie Clinic
| | - Burt Cagir
- Colorectal Surgery, Robert Packer Hospital/Guthrie Clinic
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Ciarrocchi A, Pietroletti R, Carlei F, Amicucci G. Extensive surgery and lymphadenectomy do not improve survival in primary melanoma of the anorectum: results from analysis of a large database (SEER). Colorectal Dis 2017; 19:158-164. [PMID: 27317493 DOI: 10.1111/codi.13412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/17/2016] [Indexed: 12/24/2022]
Abstract
AIM Primary anorectal melanoma is a rare disease with a dismal prognosis due to early distant metastasis. The prognostic value of positive loco-regional lymph nodes and the impact of lymphadenectomy on overall survival are unclear. We have investigated this by analysis of data obtained from a national representative database, controlling for potential confounders. METHODS Data were retrieved from the Surveillance, Epidemiology and End Results (SEER) database. Multiple imputation analysis was performed to deal with missing data. Cox regression models were formulated using different prognostic factors including site of origin, gender, size, race, rate of lymph node metastasis (ratio between positive lymph node count and total lymph nodes harvested), extent of lymphadenectomy (none, level I etc.), age, type of surgery, stage of disease and administration of radiotherapy. RESULTS Our population was composed of 208 patients who underwent surgery between 1998 and 2012. Rate of lymph node metastasis (P = 0.027; hazard ratio 1.873, 95% CI 1.076-3.261) and race (P = 0.019; hazard ratio 2.291, 95% CI 1.148-4.575) were found to be independent predictors of survival. CONCLUSION Based on the data retrieved from the SEER database, metastasis to loco-regional lymph nodes is an important prognostic factor, but lymphadenectomy does not improve survival.
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Affiliation(s)
- A Ciarrocchi
- General and Emergency Surgery, University of L'Aquila, L'Aquila, Italy
| | - R Pietroletti
- Coloproctological Surgery University of L'Aquila, Hospital Val Vibrata, Sant'Omero (TE), Italy
| | - F Carlei
- Postgraduate School of Digestive Surgery, University of L'Aquila, L'Aquila, Italy
| | - G Amicucci
- General and Emergency Surgery, University of L'Aquila, L'Aquila, Italy
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Roy AC, Wattchow D, Astill D, Singh S, Pendlebury S, Gormly K, Segelov E. Uncommon Anal Neoplasms. Surg Oncol Clin N Am 2017; 26:143-161. [DOI: 10.1016/j.soc.2016.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Here, we report 12 cases of anorectal malignant melanoma (ARMM), which has a very rare incidence. Patients were examined by either computed tomography or MRI or computed tomography combined with MRI before they underwent a remission operation. Because of the paramagnetic contribution from melanin, the short T(1) and short T(2) signals in MRI were specific to melanoma. MRI is reliable in the early diagnosis of ARMM, which is confirmed by pathological reports. Therefore, we advocate the application of a radiological screen using MRI for those patients with a mole in the anorectal region and abnormal colonoscopy findings.
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Chen H, Cai Y, Liu Y, He J, Hu Y, Xiao Q, Hu W, Ding K. Incidence, Surgical Treatment, and Prognosis of Anorectal Melanoma From 1973 to 2011: A Population-Based SEER Analysis. Medicine (Baltimore) 2016; 95:e2770. [PMID: 26886623 PMCID: PMC4998623 DOI: 10.1097/md.0000000000002770] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Anorectal melanoma (AM) is a rare type of melanoma that accounts for 0.4% to 1.6% of total malignant melanomas. The incidence of AM increases over time, and it remains highly lethal, with a 5-year survival rate of 6% to 22%. Considering the rare nature of this disease, most studies on AM comprise isolated case reports and single-center trials, which could not provide comprehensive assessment of the disease. Therefore, we conducted a population-based study by using the Surveillance, Epidemiology, and End Results (SEER) program to provide the latest and best available evidence of AM.We extracted all cases of AM registered in the SEER database from 1973 to 2011 (April 2014 release) and calculated age-adjusted incidence. Only cases with active follow-up were included to predict factors associated with prognosis. Survival outcomes were also compared among different types of surgery.We identified 640 AM cases, which consisted of 265 rectal melanoma and 375 anal melanoma. The estimated annual incidence rates of AM per 1 million population were 0.259 in males and 0.407 in females, and it increased with advanced age and over time. Tumor stage and surgical treatment were independent predictors of survival. Results implied that surgery improved the prognosis of patients with local- and regional-stage AM but could not prolong the survival of patients with distant-stage AM. Moreover, the outcome of less extensive excision was not statistically different from that of more extensive excision.This study provides an up-to-date estimation of the incidence and prognosis of AM by using SEER data. The incidence of AM continuously increases over time, despite its rarity. This disease also exhibits poor prognosis. Thus, AM must be further investigated in future studies. We also recommend surgery as the optimal treatment for local- and regional-stage AM patients but not for those with distant metastasis.
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Affiliation(s)
- Haiyan Chen
- From the Department of Surgical Oncology (HC, YC, YL, JH, YH, QX, KD),The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou ,Zhejiang, China); and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province) (HC, YC, YL, JH, YH, QX, WH, KD), The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Anorectal malignant melanoma with extensive intraepithelial extension: report of a case. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-015-0211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma: a systematic review. Ann Surg 2015; 261:670-7. [PMID: 25119122 DOI: 10.1097/sla.0000000000000862] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether the extent of surgery is associated with survival in anorectal malignant melanoma (ARMM). BACKGROUND ARMM is a rare and highly malignant neoplasm with unfavorable prognosis. The optimal surgical management, abdominoperineal resection (APR) or local excision (LE), has been long debated, but conclusive evidence has not been obtained. METHODS A comprehensive electronic literature search was performed to identify studies evaluating survival between APR and LE for ARMM. The main outcome measures were overall survival, relapse-free survival, and local recurrence. A meta-analysis was performed using the random-effects models to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Thirty-one studies, with a total of 1006 patients [544 (54.1%) APR and 462 (45.9%) LE], were included. Meta-analyses showed that overall survival (OR, 1.14; 95% CI, 0.74-1.76; P = 0.54) and relapse-free survival (OR, 0.95; 95% CI, 0.43-2.09; P = 0.89) did not differ significantly between the APR and LE groups. APR significantly reduced local recurrence compared with LE (OR, 0.18; 95% CI, 0.09-0.36; P < 0.00001). CONCLUSIONS Although several limitations, such as inclusion of only retrospective studies with relatively small sample size and selection biases for surgical procedure, are involved, this meta-analysis suggested that APR has no survival benefit; however, APR confers better local control than LE. Given that local failures after LE could be managed by salvage surgery, minimizing morbidity and maximizing quality of life should be the focus in surgical treatment of ARMM.
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