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Vol. 34. Num. 1.January - April 2014
Pages 1-64
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Vol. 34. Num. 1.January - April 2014
Pages 1-64
Original article
DOI: 10.1016/j.jcol.2013.12.005
Anal melanoma: a rare, but catastrophic tumor
Melanoma anal: tumor raro, mas catastrófico
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Andréa da Costa Veloso, Jaime Coelho Carlos Magno, José Antonio Dias da Cunha e Silva
Corresponding author
joseantoniocunha@yahoo.com.br

Corresponding author.
Colorectal Division of Hospital Naval Marcílio Dias, Rio de Janeiro, RJ, Brazil
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Article information
Abstract
Introduction

Malignant melanoma of the anal canal is a rare and aggressive disease, which early diagnosis is difficult. Its presentation with no specific symptoms leads to a late diagnosis at an advanced stage. The prognosis of anorectal malignant melanoma is poor and frequently related to distant metastasis and absence of response of chemoradiotherapy. Surgery remains the mainstay of therapy; otherwise, the best approach is controversial. Considering no survival benefits for APR, wide local excision should be considered as the treatment of choice.

Methods

This report collects nine cases of anorectal melanoma treated at our division from 1977 to 2006, as well as a review of the literature.

Results

There were eight females and one male, of medium age 69 years (range: 41-85 years). Most frequent presentation was bleeding. Wide Local Excision (WLE) was performed in seven of them. Mean survival was 24 months, and six of them died on account of metastatic disease.

Conclusion

Anorectal melanoma remains challenging. Efforts should be taken to early diagnosis, and wide local excision with negative margins is the preferred treatment. Abdominoperineal resection (APR) is a reasonable option for bulky tumors or when the sphincter is invaded.

Keywords:
Anal Rectal Melanoma
Resumo
Introdução

O melanoma maligno do canal anal é uma doença rara e agressiva, em que o diagnóstico precoce se torna difícil. Apresenta-se sem sintomas específicos, levando ao diagnóstico tardio e em fase avançada. O prognóstico é ruim e frequentemente relacionado a metástases a distância, bem como à ausência de resposta à rádio e à quimioterapia. A cirurgia permanece como terapia de escolha, no entanto a melhor abordagem ainda é controversa. Considerando não haver benefício na sobrevida da amputação abdômino-aerineal do aeto (AAPR), a excisão local ampla deve ser considerada o tratamento de escolha.

Métodos

São nove casos de melanoma anorretal tratados no serviço de coloproctologia do Hospital Naval Marcílio Dias (HNMD) de 1977 a 2006.

Resultados

Foram diagnosticados oito mulheres e um homem, com média de idade de 69 anos (41 - 85). A queixa mais frequente foi o sangramento anal. A excisão local ampla foi realizada em sete pacientes. A sobrevida média foi de 24 meses.

Conclusão

O melanoma anorretal continua desafiante. Todos os esforços devem ser feitos para o diagnóstico precoce, tornando assim possível realizar a excisão local com margens negativas. A AAPR ainda é uma opção factível para tumores avançados ou quando o esfíncter anal está comprometido.

Palavras-chave:
Anal
Reto
Melanoma
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Copyright © 2014. Sociedade Brasileira de Coloproctologia
Idiomas
Journal of Coloproctology

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