Malignant melanoma of the anorectal region: Two cases of prolonged survival

✍ Scribed by L. S. Freedman

• Publisher: John Wiley and Sons
• Year: 1984
• Tongue: English
• Weight: 675 KB
• Volume: 71
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800710237

✦ Synopsis

Malignant melanoma of the anorectal region is rare and carries a poor prognosis, with few cases surviving more than 5 years. We report 2 advanced cases with mesenteric lymph node involvement, where survival has been longer than 10 years.

Case reports

Case 1

A 3 1 -year-old man was admitted with symptoms of rectal bleeding and diarrhoea for one year. Digital examination and proctoscopy revealed a 2 cm polypoidal lesion in the anal canal. This was biopsied and histological examination demonstrated malignant melanoma. Pre-operatively a course of external tele-cobalt radiotherapy totalling I800 rad was given to the perineum over a 3-day period, in 3 doses of 600 rad each. This was followed by abdominoperineal excision ofthe rectum, and at the time ofoperation the liver was noted to be normal. Postoperatively chemotherapy was administered, vinblastine was given, but unfortunately the relevant dosage schedule is not available. Twelve years later the patient remains well and clinically free from recurrence.

Pathological examination of the specimen showed a pedunculated lesion 2 x 3 cm at the anorectal junction. Histology revealed a poorly differentiated malignant melanoma of epithelioid type, greater than 13 mm in depth (Figure 1). The pedicle was free of tumour. Of the mesenteric lymph nodes, only one was histologically examined and this was partially replaced with tumour.