Document Detail


Anal versus rectal melanoma: does site of origin predict outcome?
MedLine Citation:
PMID:  23303142     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Anatomic site is a predictive factor in subtypes of cutaneous and mucosal melanoma.
OBJECTIVE: The aim of this study was to examine the clinical relevance of location of origin of anorectal melanoma as a prognostic factor.
DESIGN: With the use of a prospectively maintained database, clinical characteristics, management, and outcomes were compared according to the site of origin. SETTINGS, PATIENTS, INTERVENTIONS: A retrospective review was conducted of patients diagnosed with anorectal melanoma from 1994 to 2010. Tumors were defined as anal, anorectal, or rectal melanoma according to their anatomic relationship to the dentate line.
MAIN OUTCOME MEASURES: Clinicopathologic factors were compared by χ2 test. Time-to-event analysis was performed by Kaplan-Meier analysis.
RESULTS: Of the 96 patients included (41 with anal melanoma, 32 with anorectal melanoma, 23 with rectal melanoma), patients with rectal and anorectal mucosal melanoma had advanced primary tumors (median Breslow thickness, 12 mm and 8 mm, p = 0.002), whereas anal lesions could be found at earlier depths (median thickness, 6.5 mm). Patients with anal tumors more commonly underwent transanal excision (p < 0.02) and sentinel lymph node biopsy (p = 0.004) versus anorectal and rectal tumors. Patterns of recurrence were also distinct; nearly two-thirds of anorectal and rectal tumors recurred systemically, whereas anal melanoma more often recurred within the lymph nodes first (63%; p < 0.02). Recurrence occurred in 24 (59%) patients with anal tumors, 23 (72%) patients with anorectal tumors, and 16 (70%) patients with rectal tumors. Median overall survival was 22 months for anal melanoma, 28 months for anorectal melanoma, and 27 months for rectal melanoma. Recurrence and survival were not statistically different between the groups.
LIMITATIONS: This study is limited by small sample size and its retrospective nature.
CONCLUSIONS: This study represents the only series describing the outcomes of anorectal melanoma by anatomic location. Lesions at or proximal to the dentate line present with more advanced disease, possibly related to a delay in diagnosis. Lesions distal to the dentate line more commonly recur within lymph nodes, which may represent differences in nodal drainage. Irrespective of location, the long-term prognosis remains poor for all cases of anorectal melanoma.
Authors:
Danielle M Bello; Elizabeth Smyth; Daniel Perez; Shaheer Khan; Larissa K Temple; Charlotte E Ariyan; Martin R Weiser; Richard D Carvajal
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  56     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-10     Completed Date:  2013-02-28     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  150-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anus Neoplasms / mortality,  pathology
Female
Humans
Kaplan-Meier Estimate
Male
Melanoma / mortality,  pathology*
Middle Aged
Neoplasm Recurrence, Local / pathology
Prognosis
Rectal Neoplasms / mortality,  pathology*
Retrospective Studies
Sentinel Lymph Node Biopsy
Grant Support
ID/Acronym/Agency:
T32 CA009501/CA/NCI NIH HHS
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