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Patterns of Failure in Anorectal Melanoma: A Guide to Surgical Therapy

Patterns of Failure in Anorectal Melanoma: A Guide to Surgical Therapy Abstract •Anorectal melanoma is an aggressive tumor with a reported 5-year survival rate of 6%. Recommendations for local surgical therapy vary from local excision to abdominoperineal resection. Therapy, patterns of failure, and survival were retrospectively examined in 32 patients with anorectal melanoma. Twenty-six patients were treated surgically, 14 with abdominoperineal resection and 12 with local excision. Local recurrence occurred less frequently in patients undergoing abdominoperineal resection (4 [29%] of 14) compared with patients undergoing local excision (7 [58%] of 12) but developed concomitantly with distant or regional metastasis in all but 2 of the 11 patients whose operations failed locally. Inguinal nodal disease developed in 15 patients (47%). Pelvic nodal disease became apparent in only 2 patients (7%). There was no difference in overall survival between the two surgically treated groups (median survival, 19.5 months for patients treated with abdominoperineal resection vs 18.9 months for patients treated with local excision). Therefore, local excision is recommended when technically feasible since these patients eventually succumb to metastasis regardless of surgical therapy. (Arch Surg. 1990;125:313-316) References 1. Pack GT, Oropeza R. A Comparative study of melanoma and epidermoid carcinoma of the anal canal: a review of 20 melanomas and 29 epidermoid carcinomas . Dis Colon Rectum . 1967;10:161-176.Crossref 2. Pickard R, McBride CM. Anorectal melanoma . In: Neoplasms of the Skin and Malignant Melanoma . Chicago, Ill: Year Book Medical Publishers Inc; 1976:443-451. 3. Remingo PA, Der BK, Fosberg RT. Anorectal melanoma: report of two cases . Dis Colon Rectum . 1976;19:350-356.Crossref 4. Raven RW. Anorectal malignant melanoma . Proc R Soc Med . 1918;41:469-474. 5. Sinclair DM, Hannah G, McLaughlin IS, Patrick RS, Slavin G, Neville AM. Malignant melanoma of the anal canal . Br J Surg . 1957;57:808-811.Crossref 6. Singh W, Madaan TR. Malignant melanoma of the anal canal . Am J Proctol . 1976;27:49-55. 7. 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.Crossref 8. Bolivar JC, Harris JW, Branch W, Sherman R. Melanoma of the anorectal region . Surg Gynecol Obstet . 1982;154:337-341. 9. Ward MWN, Romano G, Nicholls RJ. The surgical treatment of anorectal malignant melanoma . Br J Surg . 1986;73:68-69.Crossref 10. Siegal B, Cohen D, Jacob E. Surgical treatment of anorectal melanomas . Am J Surg . 1983;146:336-338.Crossref 11. Gehan EA. Statistical methods for survival time studies . In: Staquet MJ, ed. Cancer Therapy, Prognostic Factors and Criteria of Response . New York, NY: Raven Press; 1975:7-35. 12. Smith T, Gehan EA. A computer program for estimating survival functions for the life table . Comput Programs in Biomed . 1970;1:58-64.Crossref 13. Lee E, Desu M. A computer program for comparing K samples with right-censored data . Comput Programs in Biomed . 1972;2:315-321.Crossref 14. Wanebo HJ, Woodruff JM, Farr GH, Quan SH. Anorectal melanoma . Cancer . 1981;47:1891-1900.Crossref 15. Chiu YS, Unni KK, Beart RW. Malignant melanoma of the anorectum . Dis Colon Rectum . 1980;23:122-124.Crossref 16. Abbas JS, Karakousis CP, Holyoke ED. Anorectal melanoma: clinical features, recurrence, and patient survival . Int Surg . 1980;65:423-426. 17. Cooper P, Mills SE, Allen S. Malignant melanoma of the anus . Dis Colon Rectum . 1982;25:693-703.Crossref 18. Morson BC, Volkstadt H. Malignant melanoma of the anal canal . J Clin Pathol . 1963;16:126-132.Crossref 19. Paradis P, Douglass HO, Holyoke ED. The clinical implications of a staging system for carcinoma of the anus . Surg Gynecol Obstet . 1975;141:411-416. 20. Werdin C, Limas C, Knodell RG. Primary malignant melanoma of the rectum: evidence for origination from rectal mucosal melanocytes . Cancer . 1988;61:1364-1370.Crossref 21. Alexander RM, Cone LA. Malignant melanoma of the rectal ampulla: repeat of a case and review of the literature . Dis Colon Rectum . 1977;20:53-55.Crossref 22. Mason JK, Helwig EB. Ano-rectal Melanoma . Cancer . 1966;19:39-50.Crossref 23. Urist MM, Maddox WA, Kennedy JE, Balch CM. Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients . Cancer . 1983;51:2151-2156.Crossref 24. Byers R, Peters L, Goepfert H. Adjuvant radiotherapy for high risk cutaneous melanoma of the head and neck. Read before the annual meeting of the American Society for Head and Neck Surgery; April 5, 1989; San Francisco, Calif. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Patterns of Failure in Anorectal Melanoma: A Guide to Surgical Therapy

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1990.01410150035007
Publisher site
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Abstract

Abstract •Anorectal melanoma is an aggressive tumor with a reported 5-year survival rate of 6%. Recommendations for local surgical therapy vary from local excision to abdominoperineal resection. Therapy, patterns of failure, and survival were retrospectively examined in 32 patients with anorectal melanoma. Twenty-six patients were treated surgically, 14 with abdominoperineal resection and 12 with local excision. Local recurrence occurred less frequently in patients undergoing abdominoperineal resection (4 [29%] of 14) compared with patients undergoing local excision (7 [58%] of 12) but developed concomitantly with distant or regional metastasis in all but 2 of the 11 patients whose operations failed locally. Inguinal nodal disease developed in 15 patients (47%). Pelvic nodal disease became apparent in only 2 patients (7%). There was no difference in overall survival between the two surgically treated groups (median survival, 19.5 months for patients treated with abdominoperineal resection vs 18.9 months for patients treated with local excision). Therefore, local excision is recommended when technically feasible since these patients eventually succumb to metastasis regardless of surgical therapy. (Arch Surg. 1990;125:313-316) References 1. Pack GT, Oropeza R. A Comparative study of melanoma and epidermoid carcinoma of the anal canal: a review of 20 melanomas and 29 epidermoid carcinomas . Dis Colon Rectum . 1967;10:161-176.Crossref 2. Pickard R, McBride CM. Anorectal melanoma . In: Neoplasms of the Skin and Malignant Melanoma . Chicago, Ill: Year Book Medical Publishers Inc; 1976:443-451. 3. Remingo PA, Der BK, Fosberg RT. Anorectal melanoma: report of two cases . Dis Colon Rectum . 1976;19:350-356.Crossref 4. Raven RW. Anorectal malignant melanoma . Proc R Soc Med . 1918;41:469-474. 5. Sinclair DM, Hannah G, McLaughlin IS, Patrick RS, Slavin G, Neville AM. Malignant melanoma of the anal canal . Br J Surg . 1957;57:808-811.Crossref 6. Singh W, Madaan TR. Malignant melanoma of the anal canal . Am J Proctol . 1976;27:49-55. 7. 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.Crossref 8. Bolivar JC, Harris JW, Branch W, Sherman R. Melanoma of the anorectal region . Surg Gynecol Obstet . 1982;154:337-341. 9. Ward MWN, Romano G, Nicholls RJ. The surgical treatment of anorectal malignant melanoma . Br J Surg . 1986;73:68-69.Crossref 10. Siegal B, Cohen D, Jacob E. Surgical treatment of anorectal melanomas . Am J Surg . 1983;146:336-338.Crossref 11. Gehan EA. Statistical methods for survival time studies . In: Staquet MJ, ed. Cancer Therapy, Prognostic Factors and Criteria of Response . New York, NY: Raven Press; 1975:7-35. 12. Smith T, Gehan EA. A computer program for estimating survival functions for the life table . Comput Programs in Biomed . 1970;1:58-64.Crossref 13. Lee E, Desu M. A computer program for comparing K samples with right-censored data . Comput Programs in Biomed . 1972;2:315-321.Crossref 14. Wanebo HJ, Woodruff JM, Farr GH, Quan SH. Anorectal melanoma . Cancer . 1981;47:1891-1900.Crossref 15. Chiu YS, Unni KK, Beart RW. Malignant melanoma of the anorectum . Dis Colon Rectum . 1980;23:122-124.Crossref 16. Abbas JS, Karakousis CP, Holyoke ED. Anorectal melanoma: clinical features, recurrence, and patient survival . Int Surg . 1980;65:423-426. 17. Cooper P, Mills SE, Allen S. Malignant melanoma of the anus . Dis Colon Rectum . 1982;25:693-703.Crossref 18. Morson BC, Volkstadt H. Malignant melanoma of the anal canal . J Clin Pathol . 1963;16:126-132.Crossref 19. Paradis P, Douglass HO, Holyoke ED. The clinical implications of a staging system for carcinoma of the anus . Surg Gynecol Obstet . 1975;141:411-416. 20. Werdin C, Limas C, Knodell RG. Primary malignant melanoma of the rectum: evidence for origination from rectal mucosal melanocytes . Cancer . 1988;61:1364-1370.Crossref 21. Alexander RM, Cone LA. Malignant melanoma of the rectal ampulla: repeat of a case and review of the literature . Dis Colon Rectum . 1977;20:53-55.Crossref 22. Mason JK, Helwig EB. Ano-rectal Melanoma . Cancer . 1966;19:39-50.Crossref 23. Urist MM, Maddox WA, Kennedy JE, Balch CM. Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients . Cancer . 1983;51:2151-2156.Crossref 24. Byers R, Peters L, Goepfert H. Adjuvant radiotherapy for high risk cutaneous melanoma of the head and neck. Read before the annual meeting of the American Society for Head and Neck Surgery; April 5, 1989; San Francisco, Calif.

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1990

References