Surgical management of primary anorectal melanoma

Abstract Background This aim of this study was to analyse outcome after surgery for primary anorectal melanoma and to determine factors predictive of survival. Methods Records of 40 patients treated between 1977 and 2002 were reviewed. Results Twelve men and 28 women of mean age 58·1 (range 37–83) years were included in the analysis. Overall and disease-free survival rates were 17 and 14 per cent at 5 years. Median overall survival was 17 months and disease-free survival was 10 months. The 5-year survival rate was 24 per cent for patients with stage I tumours, and zero for those with stage II or stage III disease. There was no significant difference in overall survival after wide local excision (49 and 16 per cent at 2 and 5 years respectively) and abdominoperineal resection (33 per cent at both time points). In patients with stage I and stage II disease, there was a significant association between poor survival and duration of symptoms (more than 3 months), inguinal lymph node involvement, tumour stage and presence of amelanotic melanoma. Conclusion Anorectal melanoma is a rare disease with a poor prognosis. Wide local excision is recommended as primary therapy if negative resection margins can be achieved.