Patterns of failure in anorectal melanoma. A guide to surgical therapy
M. Ross, C. Pezzi, T. Pezzi, D. Meurer, R. Hickey and C. Balch
Department of Surgery, University of Texas, M.D. Anderson Cancer Center, Houston 77030.
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.
