Download PDF
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)

    Permissions and Reprints

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.

KEYWORDS

Melanoma - anal - malignancy - abdominoperineal resection - wide local excision

REFERENCES

  • 1 Roumen R MH. Anorectal melanoma in the Netherlands: a report of 63 patients.  Eur J Surg Oncol. 1996;  22 598-601
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Molino D, Perrotti P, Antropoli C et al.. Primary anorectal melanoma.  Chir Ital. 2000;  52 329-334
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Pack G T, Lenson N, Gerber D M. Regional distribution of moles and melanomas.  Arch Surg. 1952;  65 862-870
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 7 Weinstock M. Epidemiology and prognosis of anorectal melanoma.  Gastroenterology. 1993;  104 174-178
    PubMedGoogle Scholar
  • 8 Husa A, Hockerstedt K. Anorectal malignant melanoma. A report of fourteen cases.  Acta Chir Scand. 1974;  140 68-72
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 11 Pessaux P, Pocard M, Elias D et al.. Surgical management of primary anorectal melanoma.  Br J Surg. 2004;  91 1183-1187
    PubMedGoogle Scholar
  • 12 Quan S, Deddish M. Noncutaneous melanoma: malignant melanoma of the anorectum.  CA Cancer J Clin. 1966;  16 111-114
    PubMedGoogle Scholar
  • 13 Wanebo H J, Woodruff J M, Farr G H, Quan S H. Anorectal melanoma.  Cancer. 1981;  47 1891-1900
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Abbas J S, Karakousis C P, Holyoke E D. Anorectal melanoma: clinical features, recurrence and patient survival.  Int Surg. 1980;  65 423-426
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Rossetti C, Koukouras D, Eboli M et al.. Primary anorectal melanomas: an institutional experience.  J Exp Clin Cancer Res. 1997;  16 81-85
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 26 Mutch M G, Roberts P L. Anal and peri-anal melanoma.  Clin Colon Rectal Surg. 2002;  15 271-276
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 29 Morson B C, Volkstadt H. Malignant melanoma of the anal canal.  J Clin Pathol. 1963;  1 126-132
    PubMedGoogle Scholar
  • 30 Goldman S, Glimelius B, Pahlman L. Anorectal malignant melanoma in Sweden: report of 49 patients.  Dis Colon Rectum. 1990;  33 874-877
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Nicholson A G, Cox P M, Marks C G, Cook M G. Primary malignant melanoma of the rectum.  Histopathology. 1993;  22 261-264
    PubMedGoogle Scholar
  • 33 Nozoe T, Anai H. Amelanotic malignant melanoma of the rectum: report of a case.  Surg Today. 2001;  31 527-529
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 38 Chiu Y S, Unni K K, Beart R W. Malignant melanoma of the anorectum.  Dis Colon Rectum. 1980;  23 122-124
    CrossrefPubMedGoogle Scholar
  • 39 Siegal B, Cohen D, Jacob E T. Surgical treatment of anorectal melanomas.  Am J Surg. 1983;  146 336-338
    CrossrefPubMedGoogle Scholar
  • 40 Bolivar J C, Harris J W, Branch W, Sherman R T. Melanoma of the anorectal region.  Surg Gynecol Obstet. 1982;  154 337-341
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 42 Thibault C, Sagar P, Nivatvongs S et al.. Anorectal melanoma-an incurable disease?.  Dis Colon Rectum. 1997;  40 661-668
    CrossrefPubMedGoogle Scholar
  • 43 Luna-Perez P, Rodrigez D F, Macouzet J G et al.. Anorectal malignant melanoma.  Surg Oncol. 1996;  5 165-168
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 46 Ward M W, Romano G, Nicholls R J. The surgical treatment of anorectal malignant melanoma.  Br J Surg. 1986;  73 68-69
    CrossrefPubMedGoogle Scholar
  • 47 Yap L B, Neary P. A comparison of wide local excision with abdominoperineal resection in anorectal melanoma.  Melanoma Research. 2004;  14 147-150
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 56 Thompson L W, Brinckerhoff L, Slingluff C L. Vaccination for melanoma.  Curr Oncol Rep. 2000;  2 292-299
    PubMedGoogle Scholar
  • 57 Hershey P. Evaluation of vaccine viral lysates as therapeutic vaccines in the treatment of melanoma.  Ann NY Acad Sci. 1993;  690 167-177
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 60 Haigh P I, Difronzo L A, Gammon G, Morton D L. Vaccine therapy for patients with melanoma.  Oncology. 1999;  13 1561-1574
    PubMedGoogle Scholar
  • 61 Nyui S, Osanai H, Masuoka H et al.. Anorectal malignant melanoma: report of a case.  Surg Today. 1997;  27 753-756
    CrossrefPubMedGoogle Scholar
  • 62 Terada R, Ito S, Kobayashi M et al.. Anorectal melanoma: successful treatment by surgical excision and combination chemoimmunotherapy.  Hepatogastroenterology. 2002;  49 1545-1548
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 69 Phade V R, Lawrence W R. Anorectal melanoma.  Br J Surg. 1981;  68 667-668
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 74 Kim K B, Sanguino A M, Hodges C et al.. Biochemotherapy in patients with metastatic anorectal mucosal melanoma.  Cancer. 2004;  100 1478-1483
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 78 Stevens G, Thompson J F, Firth I et al.. Locally advanced melanoma: results of postoperative hypofractionated radiation therapy.  Cancer. 2000;  88 88-94
    CrossrefPubMedGoogle Scholar
  • 79 Bentzen S M, Overgaard J, Thames H D et al.. Clinical radiobiology of malignant melanoma.  Radiother Oncol. 1989;  16 169-182
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 81 Konstadoulakis M M, Ricaniadis N, Walsh D. Malignant melanoma of the anorectal region.  J Surg Oncol. 1995;  58 118-120
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 84 Sersa G, Cemazar M, Rudolf Z. Electrochemotherapy: advantages and drawbacks in treatment of cancer patients.  Cancer Ther. 2003;  1 133-142
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

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

      >