Surgical Management of Primary Anorectal Melanoma: Is Less More?

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• The Ano-uro-genital (AUG) Mucosal Melanoma UK guidelines advocate for less radical surgical strategies in anorectal melanoma (ARM) when feasible.
• This study reports on the clinical experience with ARM management following these less radical surgical principles.

Purpose of the Study:

• To evaluate the clinical presentation, surgical intervention, and oncological outcomes of patients with anorectal melanoma (ARM) treated with a less radical surgical approach.
• To assess the feasibility and effectiveness of conservative surgical management for ARM in line with current guidelines.

Main Methods:

• A retrospective study of 15 consecutive patients with ARM who underwent surgical treatment between November 2014 and April 2023.
• Patients were categorized into two surgical groups: wide local excision (WLE, n=9) and abdominoperineal resection (APR, n=6).
• Demographic, diagnostic, treatment, and oncological outcome data were analyzed and compared between the WLE and APR groups.

Main Results:

• The mean patient age was 65.3 years, with 40% being female. Most patients (60%) were diagnosed with Stage I disease.
• R0 margins were achieved in all cases. The mean length of hospital stay was significantly lower for WLE (2.6 days) compared to APR (14.0 days) (p=0.032).
• Local/distant recurrence rates were similar between WLE (55.5%) and APR (50.0%) (p=0.707), with comparable median overall survival (38.5 months for WLE vs. 26.5 months for APR).

Conclusions:

• Achieving clear surgical margins through less radical procedures may yield oncological outcomes comparable to radical surgery for ARM.
• This approach has the potential to reduce patient morbidity and preserve anorectal function.
• The surgical management of ARM, adhering to the 'less is more' principle consistent with AUG guidelines, demonstrates acceptable outcomes.