Patterns of Care and Survival Outcomes in the Treatment of Anal Melanoma

  • Jaffer Naqvi
  • Anna LeeEmail author
  • Ariel Lederman
  • Ami Kavi
  • Virginia W. Osborn
  • David Schreiber
Original Research



Anal mucosal melanoma is an uncommon malignancy of the anal canal, with few large studies available to establish clear trends in the treatment modalities presently available. The primary goal of this study was to identify the patterns of care in the treatment of anal melanoma and secondarily to determine outcomes.


This was a retrospective study performed utilizing the National Cancer Database (NCDB). A total of 787 patients diagnosed with anal melanoma between 2004 and 2014 were selected, of which 398 had staging information. The four treatment groups analyzed were surgical excision alone, surgical excision and radiation therapy, surgical excision and immunotherapy/chemotherapy, and radiation therapy plus minus immunotherapy/chemotherapy. Treatment was grouped by extent of disease; the Kaplan-Meier method was used to analyze overall survival and multivariate Cox proportional model was used to identify factors associated with overall survival.


The majority of patients presented with either node-positive (39.4%) or metastatic disease (37.4%). Patients with surgical excision and radiation therapy had the highest median survival at 32.3 months. This is in contrast with those receiving surgical excision alone (22.9 months), surgery and immunotherapy/chemotherapy (18.4 months), and radiation without surgery (5.1 months) (p < 0.0001).


Treatment with surgical excision was the most common initial treatment with no single modality superior over another in this rare entity.


Anal melanoma NCDB Mucosal 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Financial Disclosure

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


  1. 1.
    Roy AC, Wattchow D, Astill D, Singh S, Pendlebury S, Gormly K, et al. Uncommon anal neoplasms. Surg Oncol Clin N Am. 2017;26(1):143–61.CrossRefGoogle Scholar
  2. 2.
    Bello DM, Smyth E, Perez D, Khan S, Temple LK, Ariyan CE, et al. Anal versus rectal melanoma: does site of origin predict outcome? Dis Colon Rectum. 2013;56(2):150–7.CrossRefGoogle Scholar
  3. 3.
    Nam S, Kim CW, Baek SJ, Hur H, Min BS, Baik SH, et al. The clinical features and optimal treatment of anorectal malignant melanoma. Annals of surgical treatment and research. 2014;87(3):113–7.CrossRefGoogle Scholar
  4. 4.
    Kiran RP, Rottoli M, Pokala N, Fazio VW. Long-term outcomes after local excision and radical surgery for anal melanoma: data from a population database. Dis Colon Rectum. 2010;53(4):402–8.CrossRefGoogle Scholar
  5. 5.
    Belli F, Gallino GF, Lo Vullo S, Mariani L, Poiasina E, Leo E. Melanoma of the anorectal region: the experience of the National Cancer Institute of Milano. Eur J Surg Oncol : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2009;35(7):757–62.CrossRefGoogle Scholar
  6. 6.
    Moozar KL, Wong CS, Couture J. Anorectal malignant melanoma: treatment with surgery or radiation therapy, or both, Canadian journal of surgery. J Canadien de chirurgie. 2003;46(5):345–9.Google Scholar
  7. 7.
    Kelly P, Zagars GK, Cormier JN, Ross MI, Guadagnolo BA. Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma: a 20-year experience. Cancer. 2011;117(20):4747–55.CrossRefGoogle Scholar
  8. 8.
    Chen H, Cai Y, Liu Y, He J, Hu Y, Xiao Q, et al. Incidence, surgical treatment, and prognosis of anorectal melanoma from 1973 to 2011: a population-based SEER analysis. Medicine. 2016;95(7):e2770.CrossRefGoogle Scholar
  9. 9.
    Heppt MV, Roesch A, Weide B, Gutzmer R, Meier F, Loquai C, et al. Prognostic factors and treatment outcomes in 444 patients with mucosal melanoma. Eur J Cancer (Oxford, England : 1990). 2017;81:36–44.CrossRefGoogle Scholar
  10. 10.
    McLaughlin CC, Wu XC, Jemal A, Martin HJ, Roche LM, Chen VW. Incidence of noncutaneous melanomas in the U.S. Cancer. 2005;103(5):1000–7.CrossRefGoogle Scholar
  11. 11.
    Cote TR, Sobin LH. Primary melanomas of the esophagus and anorectum: epidemiologic comparison with melanoma of the skin. Melanoma Res. 2009;19(1):58–60.CrossRefGoogle Scholar
  12. 12.
    Callahan A, Anderson WF, Patel S, Barnholtz-Sloan JS, Bordeaux JS, Tucker MA, et al. Epidemiology of anorectal melanoma in the United States: 1992 to 2011. Dermatol Surg : official publication for American Society for Dermatologic Surgery [et al]. 2016;42(1):94–9.CrossRefGoogle Scholar
  13. 13.
    Stefanou A, Nalamati SP. Anorectal melanoma. Clin Colon Rectal Surg. 2011;24(3):171–6.CrossRefGoogle Scholar
  14. 14.
    Iddings DM, Fleisig AJ, Chen SL, Faries MB, Morton DL. Practice patterns and outcomes for anorectal melanoma in the USA, reviewing three decades of treatment: is more extensive surgical resection beneficial in all patients? Ann Surg Oncol. 2010;17(1):40–4.CrossRefGoogle Scholar
  15. 15.
    Yeh JJ, Shia J, Hwu WJ, Busam KJ, Paty PB, Guillem JG, et al. The role of abdominoperineal resection as surgical therapy for anorectal melanoma. Ann Surg. 2006;244(6):1012–7.CrossRefGoogle Scholar
  16. 16.
    Droesch JT, Flum DR, Mann GN. Wide local excision or abdominoperineal resection as the initial treatment for anorectal melanoma? Am J Surg. 2005;189(4):446–9.CrossRefGoogle Scholar
  17. 17.
    Pessaux P, Pocard M, Elias D, Duvillard P, Avril MF, Zimmerman P, et al. Surgical management of primary anorectal melanoma. Br J Surg. 2004;91(9):1183–7.CrossRefGoogle Scholar
  18. 18.
    Row D, Weiser MR. Anorectal melanoma. Clin Colon Rectal Surg. 2009;22(2):120–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologySUNY Downstate Medical CenterBrooklynUSA
  2. 2.Department of Veterans AffairsNew York Harbor Healthcare SystemBrooklynUSA
  3. 3.Department of Radiation OncologyElmhurst Hospital CenterQueensUSA
  4. 4.Summit Medical GroupBerkeley HeightsUSA

Personalised recommendations