Clin Colon Rectal Surg 2006; 19(2): 078-087
DOI: 10.1055/s-2006-942348
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Anal Melanoma

Marc Singer1 , Matthew G. Mutch1
  • 1Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
Further Information

Publication History

Publication Date:
23 May 2006 (online)

ABSTRACT

Anal melanoma is rare and aggressive malignancy. Patients commonly present with advanced, even metastatic disease. Unlike cutaneous melanoma, anal melanoma has no known risk factors. Surgical excision remains the cornerstone of therapy. There are no long-term survivors of stage II or III disease; therefore, early diagnosis and treatment remain crucial. There are no trials definitively proving abdominal perineal resection (APR) or wide local excision (WLE) to yield superior long-term survival. APR may offer a higher rate of local control, whereas WLE offers a much less morbid operation. Adjuvant chemotherapy, interferon, and radiation may offer some benefit.

REFERENCES

  • 1 Roumen R MH. Anorectal melanoma in the Netherlands: a report of 63 patients.  Eur J Surg Oncol. 1996;  22 598-601
  • 2 Bullard K M, Tuttle T M, Rothenberger D A et al.. Surgical therapy for anorectal melanoma.  J Am Coll Surg. 2003;  196 206-211
  • 3 Molino D, Perrotti P, Antropoli C et al.. Primary anorectal melanoma.  Chir Ital. 2000;  52 329-334
  • 4 Chang A E, Karnell L H, Menck H R. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade.  Cancer. 1998;  83 1664-1678
  • 5 Pack G T, Lenson N, Gerber D M. Regional distribution of moles and melanomas.  Arch Surg. 1952;  65 862-870
  • 6 Miller B J, Rutherford L F, McLeod G R, Cohen J R. Where the sun never shines: anorectal melanoma.  Aust NZ J Surg. 1997;  67 846-848
  • 7 Weinstock M. Epidemiology and prognosis of anorectal melanoma.  Gastroenterology. 1993;  104 174-178
  • 8 Husa A, Hockerstedt K. Anorectal malignant melanoma. A report of fourteen cases.  Acta Chir Scand. 1974;  140 68-72
  • 9 Ollila D W, Essner R, Wanek L A, Morton D L. Surgical resection for melanoma metastatic to the gastrointestinal tract.  Arch Surg. 1996;  131 975-980
  • 10 Pandey M, Mathew A, Abraham E K, Ahamed I M, Nair K M. Primary malignant melanoma of the mucous membranes.  Eur J Surg Oncol. 1998;  24 303-307
  • 11 Pessaux P, Pocard M, Elias D et al.. Surgical management of primary anorectal melanoma.  Br J Surg. 2004;  91 1183-1187
  • 12 Quan S, Deddish M. Noncutaneous melanoma: malignant melanoma of the anorectum.  CA Cancer J Clin. 1966;  16 111-114
  • 13 Wanebo H J, Woodruff J M, Farr G H, Quan S H. Anorectal melanoma.  Cancer. 1981;  47 1891-1900
  • 14 Pack G T, Oropeza R. A comparative study of melanoma and epidermoid carcinoma of the anal canal: a review of 20 melanomas and 29 epidermoid carcinomas (1930-1965).  Dis Colon Rectum. 1967;  10 161-176
  • 15 Abbas J S, Karakousis C P, Holyoke E D. Anorectal melanoma: clinical features, recurrence and patient survival.  Int Surg. 1980;  65 423-426
  • 16 Brady M S, Kavolius J P, Quan S HQ. Anorectal melanoma: a 64-year experience at Memorial Sloan Kettering Cancer Center.  Dis Colon Rectum. 1995;  38 146-151
  • 17 Rossetti C, Koukouras D, Eboli M et al.. Primary anorectal melanomas: an institutional experience.  J Exp Clin Cancer Res. 1997;  16 81-85
  • 18 Weyandt G H, Eggert A O, Houf M et al.. Anorectal melanoma: surgical management guidelines according to tumour thickness.  Br J Cancer. 2003;  89 2019-2022
  • 19 Ballo M T, Gershenwald J E, Zagars G K et al.. Sphincter sparing local excision and adjuvant radiation for anorectal melanoma.  J Clin Oncol. 2002;  20 4555-4558
  • 20 Droesch J T, Flum D R, Mann G N. Wide local excision or abdominoperineal resection as the initial treatment for anorectal melanoma?.  Am J Surg. 2005;  189 446-449
  • 21 Cagir B, Whiteford M H, Topham A, Rakinic J, Fry R D. Changing epidemiology of anorectal melanoma.  Dis Colon Rectum. 1999;  42 1203-1208
  • 22 Slingluff C, Collmer R, Seigler H. Anorectal melanoma: clinical characteristics and results of surgical management in twenty-four patients.  Surgery. 1990;  107 1-9
  • 23 Gilchrest B A, Eller M S, Geller A C et al.. The pathogenesis of melanoma induced by ultraviolet radiation.  N Engl J Med. 1999;  340 1341-1347
  • 24 Cooper P H, Mills S E, Allen Jr M S. Malignant melanoma of the anus: report of 12 patients and analysis of 255 additional cases.  Dis Colon Rectum. 1982;  25 693-703
  • 25 Ben-Izhak O, Bar-Chana M, Sussman L, Dobiner V et al. Ki67 antigen and PCNA proliferation markers predict survival in anorectal malignant melanoma.  Histopathology. 2002;  41 519-525
  • 26 Mutch M G, Roberts P L. Anal and peri-anal melanoma.  Clin Colon Rectal Surg. 2002;  15 271-276
  • 27 Antoniuk P M, Tjandra J J, Webb B W et al.. Anorectal malignant melanoma has a poor prognosis.  Int J Colorectal Dis. 1993;  8 81-86
  • 28 Felz M W, Winburn G B, Kallab A M et al.. Anal melanoma: an aggressive malignancy masquerading as hemorrhoids.  South Med J. 2001;  94 880-885
  • 29 Morson B C, Volkstadt H. Malignant melanoma of the anal canal.  J Clin Pathol. 1963;  1 126-132
  • 30 Goldman S, Glimelius B, Pahlman L. Anorectal malignant melanoma in Sweden: report of 49 patients.  Dis Colon Rectum. 1990;  33 874-877
  • 31 Hazzan D, Reissman P, Halak M, Resnick M B, Lotem M, Shiloni E. Primary rectal malignant melanoma: report of two cases.  Tech Coloproctol. 2001;  5 51-54
  • 32 Nicholson A G, Cox P M, Marks C G, Cook M G. Primary malignant melanoma of the rectum.  Histopathology. 1993;  22 261-264
  • 33 Nozoe T, Anai H. Amelanotic malignant melanoma of the rectum: report of a case.  Surg Today. 2001;  31 527-529
  • 34 Werdin C, Limas C, Knodell R G. Primary malignant melanoma of the rectum: evidence for origination from rectal mucosal melanocytes.  Cancer. 1988;  61 1364-1370
  • 35 Kim K W, Ha H K, Kim A Y et al.. Primary malignant melanoma of the rectum: CT findings in eight patients.  Radiology. 2004;  232 181-186
  • 36 Prichard R S, Hill A DK, Skehan S J, O'Higgins N J. Positron emission tomography for staging and management of malignant melanoma.  Br J Surg. 2002;  89 389-396
  • 37 Ross M, Pezzi C, Pezzi T et al.. Patterns of failure in anorectal melanoma. A guide to surgical therapy.  Arch Surg. 1990;  125 313-316
  • 38 Chiu Y S, Unni K K, Beart R W. Malignant melanoma of the anorectum.  Dis Colon Rectum. 1980;  23 122-124
  • 39 Siegal B, Cohen D, Jacob E T. Surgical treatment of anorectal melanomas.  Am J Surg. 1983;  146 336-338
  • 40 Bolivar J C, Harris J W, Branch W, Sherman R T. Melanoma of the anorectal region.  Surg Gynecol Obstet. 1982;  154 337-341
  • 41 Baskies A M, Sugarbaker E V, Chretien P B, Deckers P J. Anorectal melanoma: the role of posterior pelvic exenteration.  Dis Colon Rectum. 1982;  25 772-777
  • 42 Thibault C, Sagar P, Nivatvongs S et al.. Anorectal melanoma-an incurable disease?.  Dis Colon Rectum. 1997;  40 661-668
  • 43 Luna-Perez P, Rodrigez D F, Macouzet J G et al.. Anorectal malignant melanoma.  Surg Oncol. 1996;  5 165-168
  • 44 Moore W. Recurrent melanoma of the rectum after previous removal from the verge of the anus in a man aged sixty-five.  Lancet. 1857;  1 290
  • 45 Miles W E. The pathology of the spread of cancer of the rectum, and its bearing upon the surgery of the cancerous rectum.  Surg Gynecol Obstet. 1931;  52 350
  • 46 Ward M W, Romano G, Nicholls R J. The surgical treatment of anorectal malignant melanoma.  Br J Surg. 1986;  73 68-69
  • 47 Yap L B, Neary P. A comparison of wide local excision with abdominoperineal resection in anorectal melanoma.  Melanoma Research. 2004;  14 147-150
  • 48 Gershenwald J E, Thompson W, Mansfield P F et al.. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.  J Clin Oncol. 1999;  17 976-983
  • 49 Morton D L, Thompson J F, Essner R et al.. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group.  Ann Surg. 1999;  230 453-465
  • 50 Balch C M, Soong S, Bartolucci A A et al.. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger.  Ann Surg. 1996;  224 255-263
  • 51 Morton D L, Hsueh E C, Essner R et al.. Prolonged survival of patients receiving active immunotherapy with Canvaxin therapeutic polyvalent vaccine after complete resection of melanoma metastatic to regional lymph nodes.  Ann Surg. 2002;  236 438-448
  • 52 Balch C M, Soong S, Ross M I et al.. Long term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0-4.0 mm). Intergroup Melanoma Surgical Trial.  Ann Surg Oncol. 2000;  7 87-97
  • 53 Eggermont A MM. Adjuvant therapy of malignant melanoma and the role of sentinel lymph node mapping.  Recent Results Cancer Res. 2000;  157 178-189
  • 54 Tien H Y, McMasters K M, Edwards M J et al.. Sentinel lymph node metastasis in anal melanoma: a case report.  Int J Gastrointest Cancer. 2002;  32 53-56
  • 55 Rosenberg S A, Zhai Y, Yang J C et al.. Immunizing patients with metastatic melanoma using recombinant adenoviruses encoding MART-1 or gp100 melanoma antigens.  J Natl Cancer Inst. 1998;  90 1894-1900
  • 56 Thompson L W, Brinckerhoff L, Slingluff C L. Vaccination for melanoma.  Curr Oncol Rep. 2000;  2 292-299
  • 57 Hershey P. Evaluation of vaccine viral lysates as therapeutic vaccines in the treatment of melanoma.  Ann NY Acad Sci. 1993;  690 167-177
  • 58 Kim E M, Sivanandham M, Stavropoulos C I et al.. Overview analysis of adjuvant therapies for melanoma-a special reference to results from vaccinia melanoma oncolysate adjuvant therapy trials.  Surg Oncol. 2001;  10 53-59
  • 59 Wallack M K, Sivanandham M, Balch C M et al.. Surgical adjuvant active specific immunotherapy for patients with stage III melanoma: the final analysis of data from a phase III, randomized, double blind, multicenter vaccinia melanoma oncolysate trial.  J Am Coll Surg. 1998;  187 69-77
  • 60 Haigh P I, Difronzo L A, Gammon G, Morton D L. Vaccine therapy for patients with melanoma.  Oncology. 1999;  13 1561-1574
  • 61 Nyui S, Osanai H, Masuoka H et al.. Anorectal malignant melanoma: report of a case.  Surg Today. 1997;  27 753-756
  • 62 Terada R, Ito S, Kobayashi M et al.. Anorectal melanoma: successful treatment by surgical excision and combination chemoimmunotherapy.  Hepatogastroenterology. 2002;  49 1545-1548
  • 63 Veronesi U, Adamus J, Aubert C et al.. A randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous melanoma.  N Engl J Med. 1982;  307 913-916
  • 64 Quirt I C, Shelley W E, Pater J L et al.. Improved survival in patients with poor-prognosis malignant melanoma treated with adjuvant levamisole: a phase III study by the National Cancer Institute of Canada Clinical Trials Group.  J Clin Oncol. 1991;  9 729-735
  • 65 Meyskens Jr F L, Kopecky K J, Taylor C W et al.. Randomized trial of adjuvant human interferon gamma versus observation in high risk cutaneous melanoma: a Southwest Oncology Group study.  J Natl Cancer Inst. 1995;  87 1710-1713
  • 66 Eggermont A MM. Strategy of the EORTC-MTG trial programmed for adjuvant treatment of moderate risk and high risk melanoma.  Eur J Cancer. 1998;  34 S22-S26
  • 67 Lens M B, Dawes M. Interferon therapy for malignant melanoma: a systematic review of randomized controlled trials.  J Clin Oncol. 2002;  20 1818-1825
  • 68 Hill G J, Krementz E T, Hill H Z. Dimethyl triazeno imidazole carboxamide and combination therapy for melanoma. IV. Late results after complete response to chemotherapy (Central Oncology Group protocols 7120, 7131 and 7131A).  Cancer. 1984;  53 1299-1305
  • 69 Phade V R, Lawrence W R. Anorectal melanoma.  Br J Surg. 1981;  68 667-668
  • 70 Ulmer A, Metzger S, Fierlbeck G. Successful palliation of stenosing anorectal melanoma by intratumoral injections with natural interferon-β.  Melanoma Res. 2002;  12 395-398
  • 71 Legha S S, Ring S, Bedikian A et al.. Treatment of metastatic melanoma with combined chemotherapy containing cisplatin, vinblastine and dacarbazine (CVD) and biotherapy using interleukin-2 and interferon-alpha.  Ann Oncol. 1996;  7 827-835
  • 72 Keilholz U, Conradt C, Legha S S et al.. Results of interleukin-2 based treatment in advanced melanoma: a case record-based analysis of 631 patients.  J Clin Oncol. 1998;  16 2921-2929
  • 73 Atkins M B, Lotze M T, Dutcher J P et al.. High-dose recombinant interleukin-2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993.  J Clin Oncol. 1999;  17 2105-2116
  • 74 Kim K B, Sanguino A M, Hodges C et al.. Biochemotherapy in patients with metastatic anorectal mucosal melanoma.  Cancer. 2004;  100 1478-1483
  • 75 Bujko K, Nowacki M P, Liszka-Dalecki P. Radiation therapy for anorectal melanoma: a report of three cases.  Acta Oncol. 1998;  37 497-499
  • 76 Ballo M T, Strom E A, Zagars G K et al.. Adjuvant irradiation for auxiliary metastases from malignant melanoma.  Int J Radiat Oncol Biol Phys. 2002;  52 964-972
  • 77 Morris K T, Marquez C M, Holland J M, Vetto J T. Prevention of local recurrence after surgical debulking of nodal and subcutaneous melanoma deposits by hypofractionated radiation.  Ann Surg Oncol. 2000;  7 680-684
  • 78 Stevens G, Thompson J F, Firth I et al.. Locally advanced melanoma: results of postoperative hypofractionated radiation therapy.  Cancer. 2000;  88 88-94
  • 79 Bentzen S M, Overgaard J, Thames H D et al.. Clinical radiobiology of malignant melanoma.  Radiother Oncol. 1989;  16 169-182
  • 80 Irvin WP Jr, Bliss S A, Rice L W et al.. Malignant melanoma of the vaginal and locoregional control: radical surgery revisited.  Gynecol Oncol. 1998;  71 476-480
  • 81 Konstadoulakis M M, Ricaniadis N, Walsh D. Malignant melanoma of the anorectal region.  J Surg Oncol. 1995;  58 118-120
  • 82 Moozar K L, Wong C S, Couture J. Anorectal malignant melanoma: treatment with surgery or radiation therapy, or both.  Can J Surg. 2003;  46 345-349
  • 83 Sersa G, Stabuc B, Cemazar M, Miklavcic D, Rudolf Z. Electrochemotherapy with cisplatin: clinical experience in malignant melanoma patients.  Clin Cancer Res. 2000;  6 863-867
  • 84 Sersa G, Cemazar M, Rudolf Z. Electrochemotherapy: advantages and drawbacks in treatment of cancer patients.  Cancer Ther. 2003;  1 133-142
  • 85 Snoj M, Rudolf Z, Cemazar M, Jancar B, Sersa G. Successful sphincter-saving treatment of anorectal melanoma with electrochemotherapy, local excision, and adjuvant brachytherapy.  Anticancer Drugs. 2005;  16 345-348

Matthew G MutchM.D. 

Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine

660 S. Euclid Ave., Box 8109, St. Louis, MO 63110-1010

Email: mutchm@wudosis.wustl.edu