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Malignant Anorectal Melanoma

Anorectum Melanoma Malignant


Presentation

  • Pigmentation was present in 9 cases. Junctional change was present in 6 cases. The mitotic rate was 3 or more per high-power field in 8 cases.[academic.oup.com]
  • Histological misdiagnosis is frequent as melanin pigment is present in only 30%. Therefore, immunohistochemistry panels can be useful: anti S-100 protein, HMB-45 and melan-A (3).[scielo.isciii.es]
  • Case presentation A 63-year-old man presented with a history of blood in the stool. Rectal examination revealed a mass in the lower rectum.[ncbi.nlm.nih.gov]
Inguinal Mass
  • Changes in bowel movements, rectal pain, and inguinal mass may also be present. Hemorrhoids, polyps, and other malignancies are the most common differential diagnoses [ 3, 4 ]. A mass is usually palpated on digital rectal examination.[ncbi.nlm.nih.gov]
Tenderness in the Right Upper Quadrant
  • Four months later, the patient was readmitted with tenderness in the right upper quadrant. Ultrasound demonstrated multiple metastatic lesions in the liver (Figure 4 ).[ncbi.nlm.nih.gov]
Abdominal Fullness
  • Abstract A 74-year-old woman was admitted to our hospital complaining of a sense of abdominal fullness.[jstage.jst.go.jp]
Flushing
  • TREATMENT ESD as an excisional biopsy was performed using a colonoscope (CF-Q260AI; Olympus Corporation, Tokyo, Japan), Flush Knife BT-S (DK2620J, FUJIFILM Medical, Tokyo, Japan), and high-frequency generator unit (VIO300D, Erbe Elektromedizin GmbH, Tuebingen[wjgnet.com]
Pigmented Tumor
  • With the diagnosis confirmed, the patient underwent a partial transanal local excision of the pigmented tumor.[scielo.org.co]

Workup

  • Three patients had extranodal disease on preoperative workup, consisting of metastases to the liver and splenic hilum in one patient, liver alone in one patient, and periportal lymph node disease in one patient.[ascopost.com]
  • Among the 7 patients treated initially with APR, 4 (57.1%) were found to have positive lymph nodes, including 2 patients who were classified as having stage I disease on initial workup.[jamanetwork.com]
  • However, there has been limited dedicated evaluation of these modalities in the workup of anorectal melanoma.[oncotarget.com]

Treatment

  • The most effective treatment strategies for PAMM remain the focus of investigation.[spandidos-publications.com]
  • The mainstay of treatment for these tumors is complete surgical resection.[tro.amegroups.com]
  • Although there is currently no consensus on the treatment methods for AMM, surgical procedures have been the most common treatment methods used until now.[wjgnet.com]
  • During the first 24 years of this period total rectal excision was regarded as the treatment of choice and since then wide local excision. Two groups of patients emerge for comparison of the results of surgical treatment.[onlinelibrary.wiley.com]
  • The response of anorectal melanoma to radiotherapy and chemotherapy is poor and optimum surgical treatment is controversial.[indianjcancer.com]

Prognosis

  • Effect of misdiagnosis on the prognosis of anorectal malignant melanoma. J Cancer Res Clin Oncol 2010;136:1401-5. DOI: 10.1007/s00432-010-0793-z. [ Links ] 3. Duarte P, Ramos R, Vicente C, et al.[scielo.isciii.es]
  • It is a clinical prognosis index of the cancer patient population. In the current case, the patient exhibited a high KPS score following surgery, which indicates a good prognosis.[spandidos-publications.com]
  • The most important predictors of prognosis are stage of disease, duration of symptoms,size of tumor and nodal status. [4] Surgical decision must therefore be individualized according to the severity of the local symptoms, presence of the distant metastasis[indianjcancer.com]
  • Prognosis should be defined by the most malignant neoplasm; therefore, management should be focused on treating the melanoma. The ASCRS 1997[journals.lww.com]
  • The prognosis of AMM is extremely poor, with a median survival of 24 mo and a 5-year survival rate of 10%[ 1 ].[wjgnet.com]

Etiology

  • ETIOLOGY • No known risk factors. • Risk factors for cutaneous melanoma like nevus, sunlight exposure does not predispose to anal melanoma. 5.[slideshare.net]
  • Case report of primary rectal melanoma and review of the etiology of melanoma. J Cutan Med Surg 2008;12:117-20. [ PUBMED ] 3. Cooper PH, Mills SE, Allen MS Jr.[jmedsoc.org]
  • While the signature UV-associated 6-4PP and CPD nucleic acid mutations are not found to be the etiology of BRAF mutations, there is evidence that faulty repair of UV-A associated oxidative damage and other UV-B associated mutations may be the etiology[jcancer.org]
  • Commonly affect female sex with, male: female ratio 0.75. [4] Anorectal melanoma located on the anal canal or at the anal verge (65%), remaining 35% located in distal rectum. [5] Etiology remains controversial.[ccij-online.org]
  • Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer . 2004 Jul 15. 101 (2):270-80. [Medline] . Učakar V, Jelen MM, Faust H, Poljak M, Dillner J, Klavs I.[emedicine.medscape.com]

Epidemiology

  • . : Changing epidemiology of anorectal melanoma. Dis. Colon Rectum, 42: 1203 – 1208, 1999. Google Scholar Crossref Medline 4.[journals.sagepub.com]
  • Weinstock MA (1993) Epidemiology and prognosis of anorectal melanoma. Gastroenterology 104:174–178 PubMed Google Scholar 6. Longo WE (1995) Rare anal canal cancers in the U.S. veteran: patterns of disease and results of treatment.[link.springer.com]
  • Changing epidemiology of anorectal melanoma. Dis Colon Rectum. 1999; 42 :1203–8. doi: 10.1007/BF02238576. [ PubMed ] [ CrossRef ] [ Google Scholar ] 5. Pessaux P, Pocard M, Elias D, Duvillard P, Avril MF, Zimmmermann P, et al.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • A further complication is that pathophysiologically, cancer of the anal margin (perianal skin) may be more closely related to penile and vulvar cancers than to cervical cancer, and the former are much less well studied than the latter. [10] In current[emedicine.medscape.com]

Prevention

  • It is an open question whether immunotherapy combined with radiotherapy is sufficient to prevent out-of-field locoregional failure. More clinical evidence is keenly awaited for addressing this important question.[tro.amegroups.com]
  • Quick and easy access to the essential content of the guidelines – PowerPoint slides and PDFs including algorithms, figures and tables – free to download Breast Cancer 4th ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC4) • Prevention[esmo.org]
  • Abstract Copyright 2016, Iranian Journal of Cancer Prevention.[intjcancermanag.com]
  • High-resolution anoscopy or expectant management for anal intraepithelial neoplasia for the prevention of anal cancer: is there really a difference?. Dis Colon Rectum . 2015 Jan. 58 (1):53-9. [Medline] . PDQ Screening and Prevention Editorial Board.[emedicine.medscape.com]

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