[Anorectal malignant melanoma : Treatment recommendations]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Dermatology

Background:

• Anorectal malignant melanoma is a rare malignancy with a poor prognosis.
• Symptoms often mimic benign conditions like hemorrhoids, delaying diagnosis.
• A high rate of amelanotic tumors further complicates early detection.

Purpose of the Study:

• To present a stage-dependent therapeutic concept for anorectal malignant melanoma.
• To guide surgical management based on tumor characteristics and stage.

Main Methods:

• Review of surgically treated patients at the institution.
• Extensive literature search of 40 treatment studies encompassing 1,970 cases.
• Analysis of prognostic factors and treatment outcomes.

Main Results:

• Surgery is the sole effective therapy for anorectal malignant melanoma.
• Local excision is adequate for tumors with clear resection margins.
• Median survival was 12 months; disease-free survival was 6 months.
• Prognostic factors include age, diagnostic delay, tumor extent, stage, and perineural invasion.

Conclusions:

• Resect locally limited tumors, preferably with local excision.
• Abdominoperineal resection is indicated for larger tumors or those involving the sphincter.
• Regional lymphadenectomy is advised for nodal metastases; palliative surgery for distant metastases or symptom control.