Abdominal perineal resection or wilde local excision in primary anorectal malignant melanoma. Case report and review

摘要

Introduction Primary anorectal malignant melanoma is a rare and aggressive tumor that carries a poor prognosis. Anorectal melanoma (ARM) is often misdiagnosed as hemorrhoids adenocarcinoma polips and rectal cancer. ARM spreads along sub-mucosal planes and is often to wide-spread for complete resection at time of diagnosis and almost all patients die because of metastases. Presentation of the case A 77-year-old male patient presented a history of recurrent rectal bleeding and whose histopathological diagnosis was melanoma. Discussion The treatment of choice remains controversial. Surgery with complete resection represents the typical treatment. However standard operative procedures related to the area of resection and lymph dissection have yet to be established. Abdominal perineal resection (APR) with or without bilateral inguinal lymphadenectomy or wide local excision (WLE) have been used to manage patients with ARM. Conclusion The higher serum levels of LDH and YKL-40 are suggestive for Anorectal Melanoma diagnosis. The decrease of these findings may be associated with good prognosis. The review of both APR and WLE options suggests no significant difference in survival among patients. Highlights ? Anorectal melanoma (ARM) is a systemic disease. ? Regardless how aggressive is ARM, no surgical treatment will truly change the outcome. ? If surgical teqchniques are available, patients should undergo to wide local excision. ? In case of recurrence, the abdominal resection should be considered as the best surgical treatment.