Abstract
Clinicopathologic features and surgical treatment of 15 patients with primary anorectal malignant melanoma were studied retrospectively. There was a female preponderance (2:1). The median age was 66 years. Common initial symptoms were rectal bleeding (87%) and/or anal pain (33%); 25% of the melanomas were amelanotic. The maximum tumor size ranged between 0.8 and 8.4 cm (median 3.0 cm). Of the tumors evaluated histologically (n=12), tumor thickness ranged from 0.9 to 11.3 mm (median 6.1 mm). All melanomas invaded at least into the subepithelial tissue (n=8) and/or the submucosa of the distal rectum (n=4), with extension into the internal anal sphincter (n=5) and lamina propria (n=3). Endoluminal ultrasound accurately demonstrated depth of invasion in 3 of 3 patients. Three (20%) patients with distant metastases at initial presentation had a mean survival of 8 mo; one of these primary melanomas measured 0.8 cm. Of 12 patients undergoing “curative” treatments — 4 by abdominoperineal resection (APR) and 8 by local excision (LE), the incidence of loco-regional recurrence was similar (2/4 and 5/8). All these 7 patients with loco-regional recurrence developed distant metastases within 3 months. The mean survival was similar between APR and LE in the total group (25 mo vs 20 mo), in the decreased (27 mo vs 24 mo) and in those treated with a curative intent (29 mo vs 22 mo). There was no long-term survivor but four patients remained tumor-free up to 19 mo after APR (n=1) or LE (n=3). Thus anorectal melanoma has a poor prognosis and, when technically feasible, LE appears to have similar results as APR.
Résumé
Les aspects clinico-pathologiques et le traitement chirurgical de 15 malades présentant un mélanome malin primitif ano-rectal ont été étudiés rétrospectivement. Il y avait une prépondérance féminine (2:1). L'âge moyen était de 66 ans. Le premier symptome commun était une rectorragie (87%) et ou une douleur anale (33%); 25% de ces mélanomes étaient achromiques. Le diamétre maximal de la tumeur était compris entre 0,8 et 8,4 cm (médiane 3,0 cm). Sur les tumeurs examinées histologiquement (n=12), l'épaisseur de la tumeru était comprise entre 0,9 et 11 mm (moyenne 6,1 mm). Tous ces mélanomes envahissaient au moins le tissu sub-épithélial (n=8) et/ou la sous muqueuse du rectum distal (n=4), avec une extension dans le sphincter anal interne (n=5) ou la lamina propria (n=3). L'échographie endorectale a montré de façon précise la profondeur de l'invasion chez 3 patients sur 3. Trois patients (20%), avec des métastases à distance lors de l'examen initial, ont eu une moyenne de survie de 8 mois. L'un de ces mélanomes primaires mesurait 0,8 cm. Sur les 12 patients ayant eu un traitement “curatif”-4 amputations abdomino-périnéales (AAP) et 8 excisions locales (LE)-l'incidence de récidive loco-régionale fut similaire (2/4 et 5/8). Tous les 7 patients avec une récidive loco-régionale ont développé des métastases à distance dans les 3 mois. La moyenne de survie était similaire après AAP ou LE dans le groupe total (25 mois versus 20 mois), chez les malades décédés (27 mois versus 24 mois), et chez ceux traités avec une intention curative (29 mois versus 22 mois). Il n'y a pas eu de survie à long terme mais 4 patients demeurent indemmes de récidive jusqu'à 19 mois après AAP (n=1) ou LE (n=3). Ainsi le mélanome ano-rectal a un pronostic défavorable et, lorsque cela est techniquement possible, l'excision locale semble avoir des résultats similaires à l'amputation abdomino-périnéales.
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Antoniuk, P.M., Tjandra, J.J., Webb, B.W. et al. Anorectal malignant melanoma has a poor prognosis. Int J Colorect Dis 8, 81–86 (1993). https://doi.org/10.1007/BF00299333
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DOI: https://doi.org/10.1007/BF00299333