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Contemporary Surgical Management and Outcomes for Anal Melanoma: A National Cancer Database Analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Anal melanoma is a rare disease with a poor prognosis. Limited data are available regarding oncologic outcomes during the last decade and surgical practice patterns. This study aimed to investigate survival and operative oncologic outcomes for patients with anal melanoma.

Methods

The National Cancer Database (2004–2013) was used to identify patients with nonmetastatic anal melanoma who underwent surgical treatment. The primary outcome was overall survival.

Results

The study enrolled 439 patients in the local excision group and 214 patients in the abdominoperineal resection (APR) group. The patients in the APR group were older (70 vs 65 years; p < 0.001) and had larger tumors (40 vs 25 mm; p < 0.001). After resection, the APR patients were more likely to have positive lymph nodes (65.7% vs 12.5%; p < 0.001) and less likely to have positive margins (10% vs 29.8%; p < 0.001). Overall survival did not differ significantly between the APR and local excision patients (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.67–1.01; p = 0.06). The patients undergoing local excision showed was a significant survival advantage for those with negative margins (HR, 0.70, 95% CI, 0.53–0.93; p = 0.009). Among the patients undergoing APR, a significant survival advantage was observed for those with negative nodes (HR, 0.50; 95% CI, 0.35–0.69; p = 0.002) and negative margins (HR, 0.34; 95% CI, 0.15–0.77; p < 0.001).

Conclusions

The overall survival of anal melanoma patients is similar after local excision and APR. Patients with positive margins, positive lymph nodes, or both have a significantly decreased overall survival.

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References

  1. Bullard KM, Tuttle TM, Rothenberger DA, et al. Surgical therapy for anorectal melanoma. J Am Coll Surg. 2003;196:206–11.

    Article  Google Scholar 

  2. Thibault C, Sagar P, Nivatvongs S, Ilstrup DM, Wolff BG. Anorectal melanoma: an incurable disease? Dis Colon Rectum. 1997;40:661–8.

    Article  CAS  Google Scholar 

  3. Yap LB, Neary P. A comparison of wide local excision with abdominoperineal resection in anorectal melanoma. Melanoma Res. 2004;14:147–50.

    Article  Google Scholar 

  4. Klas JV, Rothenberger DA, Wong WD, et al. Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes. Cancer. 1999;85:1686–93.

    Article  CAS  Google Scholar 

  5. Chen H, Cai Y, Liu Y, He J, et al. Incidence, surgical treatment, and prognosis of anorectal melanoma from 1973 to 2011. Medicine. 2016;95:e2770.

    Article  Google Scholar 

  6. Chang AE, Karnell LH, Menck HR. The National Cancer Database report on cutaneous and noncutaenous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Comission on Cancer and the American Cancer Society. Cancer. 1998;83:1664–78.

    Article  CAS  Google Scholar 

  7. Slingluff CL, Vollmer RT, Seigler HF. Anorectal melanoma: clinical characteristics and results of surgical management in twenty-four patients. Surgery. 1990;107:1–9.

    PubMed  Google Scholar 

  8. Rossetti C, Kourouras D, Eboli M, Andreola S, Bertario L. Primary anorectal melanomas: an institutional experience. J Exp Clin Cancer Res. 1997;16:81–5.

    CAS  PubMed  Google Scholar 

  9. Brady MS, Kavolius JP, Quan SH. Anorectal melanoma: a 64-year experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum. 1995;38:146–51.

    Article  CAS  Google Scholar 

  10. Weinstock MA. Epidemiology and prognosis of anorectal melanoma. Gastroenterology. 1993;104:174–8.

    Article  CAS  Google Scholar 

  11. Iddings DM, Fleisig AJ, Chen SL, Faries M, Morton DL. Practice patterns and outcomes for anorectal melanoma in the United States: is more extensive surgical resection beneficial in all patients? Ann Surg Oncol. 2010;17:40–4.

    Article  Google Scholar 

  12. Cagir B, Whiteford MH, Topham A, Rakinic J, Fry RD. Changing epidemiology of anorectal melanoma. Dis Colon Rectum. 1999;42:1203–8.

    Article  CAS  Google Scholar 

  13. Konstadoulakis MM, Ricaniadis N, Walsh D, Karakousis CP. Malignant melanoma of the anorectal region. J Surg Oncol. 1995;58:118–20.

    Article  CAS  Google Scholar 

  14. Meguerditchian A, Meterissian SH, Dunn KB. Anorectal melanoma: diagnosis and treatment. Dis Colon Rectum. 2011;54:638–44.

    Article  Google Scholar 

  15. Abbas JS, Karakousis CP, Holyoke ED. Anorectal melanoma: clinical features, recurrence, and patient survival. Int Surg. 1980;65:423–6.

    CAS  PubMed  Google Scholar 

  16. Goldman S, Glimelius B, Pahlman L. Anorectal malignant melanoma in Sweden: a report of 49 patients. Dis Colon Rectum. 1990;33:874–7.

    Article  CAS  Google Scholar 

  17. Roumen, RM. Anorectal melanoma in the Netherlands: a report of 63 patients. Eur J Surg Oncol. 1996;22:598–601.

    Article  CAS  Google Scholar 

  18. Homsi J, Garrett C. Melanoma of the anal canal: a case series. Dis Colon Rectum. 2007;50:1004–10.

    Article  Google Scholar 

  19. Yeh JJ, Shia J, Hwu WJ, et al. The role of abdominoperineal resection as surgical therapy for anorectal melanoma. Ann Surg. 2006;244:1012–7.

    Article  Google Scholar 

  20. Kiran RP, Rottoli M, Pokala N, Fazio VW. Long-term outcomes after local excision and radical surgery for anal melanoma: data from a population database. Dis Colon Rectum. 2010;53:402–8.

    Article  Google Scholar 

  21. Belli F, Gallino GF, Lo Villo S, Mariani L, Poiasina E, Leo E. Melanoma of the anorectal region: the experience of the National Cancer Institute of Milano. Eur J Oncol. 2009;35:757–62.

    Article  CAS  Google Scholar 

  22. Nilsson PJ, Ragnarsson-Olding BK. Importance of clear resection margins in anorectal malignant melanoma. Br J Surg. 2010;97:98–103.

    Article  CAS  Google Scholar 

  23. Pessaux P, Pocard M, Elias D, et al. Surgical management of primary anorectal melanoma. Br J Surg. 2004;91:1183–7.

    Article  CAS  Google Scholar 

  24. Ross M, Pezzi C, Pezzi T, Meurer D, Hickey R, Balch C. Patterns of failure in anorectal melanoma: a guide to surgical therapy. Arch Surg. 1990;125:313–6.

    Article  CAS  Google Scholar 

  25. Weyandt GH, Eggert AO, Houf M, Raulf M, Brocker EB, Becker JC. Anorectal melanoma: surgical management guidelines according to tumor thickness. Br J Cancer. 2003;89:2019–22.

    Article  CAS  Google Scholar 

  26. Ciarrocchi A, Pietroletti R, Carlei F, Amicucci G. Extensive surgery and lymphadenectomy do not improve survival in primary melanoma of the anorectum: results from analysis of a large database (SEER). Colorectal Dis. 2017;19:158–64.

    Article  CAS  Google Scholar 

  27. Perez DR, Trakarnsanga A, Shia J, et al. Locoregional lymphadenectomy in the surgical management of anorectal melanoma. Ann Surg Oncol. 2013;20;2339–44.

    Article  Google Scholar 

  28. Tien HY, McMasters KM, Edwards MK, Chao C. Sentinel lymph node metastasis in anal melanoma: a case report. Int J Gastrointest Cancer. 2002;32:53–6.

    Article  Google Scholar 

  29. Kirkwood JM, Ibrahim JG, Sondak VK, et al. High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol. 2000;18:2444–58.

    Article  CAS  Google Scholar 

  30. Ballo MT, Gershenwald JE, Zagars GK, et al. Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma. J Clin Oncol. 2002;20:4555–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    Adam C. Fields MD, Joel Goldberg MD, MPH, James Senturk MD, PhD, Lily V. Saadat MD, Joshua Jolissaint MD, Galyna Shabat MD, PhD, Jennifer Irani MD, Ronald Bleday MD & Nelya Melnitchouk MD, MSc

Authors
  1. Adam C. Fields MD
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  2. Joel Goldberg MD, MPH
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  3. James Senturk MD, PhD
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  4. Lily V. Saadat MD
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  5. Joshua Jolissaint MD
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  6. Galyna Shabat MD, PhD
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  7. Jennifer Irani MD
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  8. Ronald Bleday MD
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  9. Nelya Melnitchouk MD, MSc
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Contributions

All authors had substantial contributions to design of work, drafted work, made final approval, and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Adam C. Fields MD or Nelya Melnitchouk MD, MSc.

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Fields, A.C., Goldberg, J., Senturk, J. et al. Contemporary Surgical Management and Outcomes for Anal Melanoma: A National Cancer Database Analysis. Ann Surg Oncol 25, 3883–3888 (2018). https://doi.org/10.1245/s10434-018-6769-y

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  • DOI: https://doi.org/10.1245/s10434-018-6769-y

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