Anorectal Melanoma Management Evolution: A Narrative Review.

Area of Science:

• Oncology
• Melanoma Research
• Surgical Oncology

Background:

• Anorectal melanoma (ARM) is a rare, aggressive mucosal melanoma with distinct molecular characteristics, including frequent KIT mutations and low immunogenicity.
• It often presents late with nonspecific symptoms, leading to advanced disease at diagnosis and poor response to traditional therapies.

Purpose of the Study:

• To review the current understanding and management of Anorectal Melanoma (ARM).
• To highlight recent advances in surgical and systemic therapies for ARM.
• To identify key challenges and future directions in ARM research.

Main Methods:

• Review of current literature on Anorectal Melanoma (ARM).
• Analysis of treatment evolution from radical surgery to sphincter-preserving techniques.
• Evaluation of systemic therapy shifts from chemotherapy to immunotherapy and targeted agents.
• Assessment of emerging neoadjuvant immunotherapy strategies.

Main Results:

• Surgical management has shifted towards sphincter-preserving wide local excision with comparable outcomes to radical resection.
• Immune checkpoint inhibitors are now a cornerstone of systemic therapy; tyrosine kinase inhibitors benefit KIT-mutated tumors.
• Neoadjuvant immunotherapy shows promise in improving resectability and survival rates (up to 71-75% 3-year OS in selected cohorts).

Conclusions:

• ARM management requires a multidisciplinary approach, integrating evolving surgical techniques and modern systemic therapies.
• Key challenges include lack of a staging system, high recurrence rates, and limited durability of responses.
• Future progress relies on biomarker-driven trials, novel strategies like CAR-T therapy, and international collaboration.