SURGERY FOR ANORECTAL MALIGNANT MELONOMA: SINGLE CENTER EXPERIENCE
Erman Aytac, Nuri Okkabaz, Matthew F Kalady, Feza H Remzi, Tracy L Hull, Emre Gorgun
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio
Purpose: Anorectal malignant melanoma (AMM) is a rare disease associated with poor survival.
Currently, wide local excision is the commonly performed initial surgical approach because of the
dismal prognosis of the disease. The aim of this study, was to review long-term outcomes in patients
who underwent radical or local resection at a high volume tertiary care center.
Methods: Patients who were diagnosed with AMM between12/1983 and 10/2012 were evaluated. Data
were retrieved from the institutional review board approved prospectively maintained database.
Patients with perianal malignant melanoma, metastatic disease at the time of diagnosis, and patients
who underwent a nonsurgical treatment primarily were excluded from the analyses. Patient
characteristics and postoperative outcomes were compared between the patients undergoing radical
surgery (RS) and wide local excision (WLE). Quantitative data were reported as median (range) and
categorical data as numbers.
Results: There were 30 patients diagnosed with AMM within the study period. Twenty-one patients
met the study criteria. Ten patients underwent RS and 11 patients underwent WLE with curative intent.
The majority of the patients (n=17) presented with rectal bleeding. Age, gender, co-morbid factors,
American Society of Anesthesiologists score, location of disease, and tumor characteristics were
comparable between the groups (table). One patient received neoadjuvant chemoradiation in the RS
group. Perioperative morbidity was significantly higher after RS compared to WLE [n=6 (60 %) vs.
n=0 (0 %); p=0.004]. In the RS group, one patient was re-operated and two patients readmitted within
30 days after surgery. Numbers of patients with local [n=4 (40%) vs. n=4 (36); p>0.999] and distant
[n=4 (40%) vs. n=2 (18%); p=0.362] recurrences were comparable after RS and WLE, respectively.
Mortality was similar between the groups [n=7 (70%) vs. n=6 (55%); p>0.999] at the time of last
follow-up. Disease-free (8 vs. 9 months, p=0.235) and overall survival (53 vs. 39 months, p=0.293)
were comparable between the groups.
Conclusions: When feasible wide local excision of anorectal melanoma may provide similar oncologic
outcomes with significantly decreased morbidity compared to radical resection.