Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2021; 27(3): 267-280
Published online Jan 21, 2021. doi: 10.3748/wjg.v27.i3.267
Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature
Josh Bleicher, Jessica N Cohan, Lyen C Huang, William Peche, T Bartley Pickron, Courtney L Scaife, Tawnya L Bowles, John R Hyngstrom, Elliot A Asare
Josh Bleicher, Jessica N Cohan, Lyen C Huang, William Peche, T Bartley Pickron, Courtney L Scaife, Tawnya L Bowles, John R Hyngstrom, Elliot A Asare, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
William Peche, John R Hyngstrom, Department of Surgery, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84114, United States
Tawnya L Bowles, Elliot A Asare, Department of Surgery, Intermountain Medical Center, Murray, UT 84107, United States
Author contributions: Bleicher J, Bowles TL, Hyngstrom JR and Asare EA designed the study and created the methodology; Bleicher J and Asare EA performed data analysis; Bleicher J created the first draft of the manuscript; Asare EA supervised the research; all authors participated in data acquisition and provided edits and helped with subsequent writing.
Institutional review board statement: The Institutional Review Boards of the University of Utah and Intermountain Health Care approved this study.
Conflict-of-interest statement: I confirm that I have no financial disclosures to declare. As the corresponding author for this manuscript, I also declare that none of my co-authors have financial disclosures to declare.
Data sharing statement: Because of the small number of participants involved in this cohort and the inability to obtain informed consent, it is difficult to ensure patient anonymity in our dataset and this will not be made available. Statistical code is available from the first author at josh.bleicher@hsc.utah.edu.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elliot A Asare, MD, MS, Assistant Professor, Surgical Oncologist, Department of Surgery, Huntsman Cancer Institute at the University of Utah, 1950 Circle of Hope Drive, Suite N6345, Salt Lake City, UT 84114, United States. elliot.asare@hci.utah.edu
Received: December 1, 2020
Peer-review started: December 1, 2020
First decision: December 21, 2020
Revised: December 28, 2020
Accepted: January 7, 2021
Article in press: January 7, 2021
Published online: January 21, 2021
Processing time: 43 Days and 19 Hours
Abstract
BACKGROUND

Anorectal melanoma (ARM) is a rare disease with a poor prognosis. Evidence on optimal treatment is limited and surgical management varies widely. We hypothesized that the frequency of abdominoperineal resection used as primary treatment of ARM has decreased over the past several decades.

AIM

To update our understanding of outcomes for patients with ARM and analyze management trends around the world.

METHODS

This is a multi-institutional, retrospective study of patients treated for ARM at 7 hospitals. Hospitals included both large, academic, tertiary care centers and smaller, general community hospitals. Using prospectively maintained institutional tumor registries, we identified 24 patients diagnosed with ARM between January 2000 and May 2019. We analyzed factors prognostic for recurrence and survival. We then used Cox regression to measure overall survival (OS) and melanoma-specific survival. We also performed a literature review to assess trends in surgical management and outcomes.

RESULTS

Of the 24 patients diagnosed with ARM, 12 (50.0%) had local, 8 (33.3%) regional, and 4 (16.7%) distant disease at diagnosis. Median time to recurrence was 10.4 mo [interquartile range (IQR) 7.5-17.2] with only 2 patients (9.3%) not developing recurrence following surgical resection. Median OS was 18.8 mo (IQR 13.5-33.9). One patient is still alive without recurrence at 21.4 mo from diagnosis; no other patient survived 5 years. Primary surgical management with abdominoperineal resection (APR) vs wide excision (WE) did not lead to differences in OS [hazard ratio = 1.4 (95%CI: 0.3-6.8)]. Review of the literature revealed geographic differences in surgical management of ARM, with increased use of WE in the United States and Europe over time and more frequent use of APR in Asia and India. There was no significant improvement in survival over time.

CONCLUSION

There is wide variation in the management of ARM and survival outcomes remain poor regardless of approach. Surgical management should aim to minimize morbidity.

Keywords: Melanoma; Anorectal melanoma; Literature review; Melanoma surgery; Surgical oncology; Colorectal surgery

Core Tip: This is a retrospective study to evaluate current trends in management of anorectal melanoma (ARM). On review of 24 patients from 7 hospitals in Utah, we found that ARM is a highly lethal disease with overall survival of 18.8 mo (interquartile range 13.5-33.9) and no 5-year survivors. Only 2 patients underwent abdominoperineal resection (APR) as primary surgical management. Review of the literature demonstrated wide variation in surgical management of ARM over time and around the world. Whether APR or wide excision was used, outcomes remained poor. With this data, we recommend that surgical management should aim to minimize morbidity.