Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature

Table 1 Demographics and primary tumor characteristics for cohort with anorectal melanoma (n = 24)

Classification		n
Age, years (median, IQR)		65.5 (54-76)
	≤ 50	3 (12.5)
	51–60	7 (29.2)
	61–70	6 (25.0)
	71–80	6 (25.0)
	> 80	2 (8.3)
Sex	M	8 (33.3)
	F	16 (66.7)
Race	White	23 (95.8)
	Latino	1 (4.2)
Rural	Yes	5 (20.8)
	No	19 (79.2)
Breslow depth (mm)	≤ 5	6 (25.0)
	> 5	7 (29.2)
	Unknown	11 (45.8)
Ulceration	Present	9 (37.5)
	Absent	2 (8.3)
	Unknown	13 (54.2)
Mitoses	> 1	7 (29.2)
	Unknown	17 (70.8)
Stage	I	12 (50.0)
	II	8 (33.3)
	III	4 (16.7)

IQR: Interquartile range.

Table 2 Treatment details for cohort with anorectal melanoma (n = 24)

	Treatment
Primary operation, n	WE	15 (62.5)
	APR	2 (8.3)
	Biopsy alone	7 (29.2)
Primary nodal operation, n	SLNB	6 (25.0)
	CLND	3 (12.5)
	None	15 (62.5)
Adjuvant therapy, n1	Chemotherapy alone	0 (0)
	Radiation alone	1 (4.2)
	Interferon alone	3 (12.5)
	Checkpoint Inhibitor	3 (12.5)
	Combination chemotherapy/radiation	2 (8.3)
	Combination chemotherapy/immunotherapy	3 (12.5)
	Combination radiation/immunotherapy	1 (4.2)
	None	11 (45.8)
Surgery at recurrence2	APR	1 (9.1)
	WE	1 (9.1)
Non-operative therapies at recurrence2	Chemotherapy	1 (9.1)
	Radiation	0 (0)
	Interferon	0 (0)
	Checkpoint Inhibitor	2 (18.2)
	Combination chemotherapy/radiation	4 (26.7)
	Combination chemotherapy/immunotherapy	2 (13.3)
	Combination radiation/immunotherapy	2 (13.3)

¹Excluding patients with distant disease at diagnosis (n = 4).

²Percentages calculated from total patients with recurrence who underwent treatment (n = 8).

APR: Abdominoperineal resection; WE: Wide excision; SLNB: Sentinel lymph node biopsy; CLND: Completion lymph node dissection.

Table 3 Studies included in literature review and select outcomes

Ref.	Date published	Location	Dates included	Sample size	Median age	M/F (n)	APR/WE (n)	Median OS	APR vs WE (% survival to 5 yr)	Overall 5 yr survival (%)
Pack et al[40]	1967	Pack Medical Foundation, United States	1930-1965	20	53.51	5/15	11/3	-	-	5
Abbas et al[41]	1980	Roswell Park Memorial Institute, United States	1930-1979	20	61.7	4/16	11/7	18.81	20.1 mo vs 8.5 mo3	7
Ward et al[42]	1986	St. Mark's Hospital, United Kingdom	1932-1982	21	-	12/9	9/6	8.81	-	0
Thibault et al[21]	1996	Mayo Clinic, United States	1939-1993	50	631	15/35	26/10	261,2	18 vs 19	22
Wanebo et al[25]	1990	Memorial Sloan Kettering Cancer Center, United States	1950-1977	36	60	15/21	22/8	14	16/7 mo vs 21.5 mo3,4	8
Ross et al[27]	1990	MD Anderson Cancer Center, United States	1952-1988	32	-	-	14/12	18.6	19.5 mo vs 18.9 mo3	3
Dodds et al[43]	2019	Melanoma Institute Australia, Australia	1958-2016	43	61	21/22	20/15	24	-	16
Siegal et al[44]	1983	Sheba Medical Center, Israel	1960-1981	30	641	13/17	15/9	10.51	-	7
Roumen et al[45]	1996	Eindhoven Cancer Registry, Netherlands	1960-1995	63	66	27/36	21/18	-	-	6
Nilsson et al[46]	2010	Swedish National Cancer Registry, Sweden	1960-1999	251	73	101/150	66/86	11.2	7 vs 15, P = 0.08
Podnos et al[47]	2006	City of Hope National Medical Center, United States	1973-2001	126	69.21	39/87	-	15	-	19
Slingluff et al[48]	1990	Duke University Medical Center, United States	1974-1988	24	641	7/17	13/8	18	18 vs 12	8
Belli et al[49]	2008	National Institute of Cancer, Italy	1975-2006	40	63	19/21	13/18	17	18.5 vs 18.5, P = 0.97	-
Che et al[22]	2011	Peking Union Medical College, China	1975-2008	56	-	22/34	36/20	21	24.6 vs 9.9, P = 0.65	20
Pessaux et al[50]	2004	Institut Gustave Roussy, France	1977-2002	30	58.1	7/23	9/21	17	16 vs 33	17
Ramakrishnan et al[51]	2008	Cancer Institue (WIA), India	1980-2004	63	-	34/29	3/8	9.52	-	5
Yeh et al[26]	2006	Memorial Sloan Kettering Cancer Center, United States	1984-2003	46	59	18/28	19/27	395	32 vs 35, P = 0.665	-
Homsi et al[52]	2007	H. Lee Moffitt Cancer Center, United States	1987-2004	12	67	3/9	5/6	-	-	-
Bullard  et al[53]	2003	University of Minnesota, United States	1988-2002	15	651	6/9	4/11	186	14 mo vs 19 mo3	-
Kelly et al[10]	2010	MD Anderson Cancer Center, United States	1989-2008	54	61	19/35	0/54	29	-	30
Das et al[19]	2003	Tata Memorial Hospital, India	1990-2001	72	491	20/52	24/0	132,5	-	82
Hicks et al[28]	2014	John Hopkins Hospital, United States	1991-2012	18	64	10/8	7/11	15.5	11.5 mo vs 13.5 mo, P = 0.753	-
Yen et al[54]	2013	Chang Gung Memorial Hospital, China	1993-2011	22	58.41	8/14	12/8	-	0 vs 28.6, P = 0.06	9
Zhang et al[7]	2010	First Affiliated Hospital of Guangxi Medical University, China	1995-2007	54	54	21/33	39/15	25	30 vs 16, P = 0.28	26
Aytac et al[55]	2010	Uludag University, Turkey	1997-2004	14	58	8/6	11/3	7.5	-	0
Ishizone et al[32]	2008	Shinshu University Hospital, Japan	1997-2006	79	65.81	34/45	63/14	22	-	29
Belbaraka et al[56]	2012	National Institute of Oncology, Morocco	1998-2007	17	581	12/5	7/3	8	-	-
Choi et al[9]	2010	Samsung Medical Center, South Korea	1999-2008	19	61	8/11	12/7	45.9	50 vs 0	32
Miguel et al[23]	2015	IPOFG, Portugal	2000-2011	10	70.5	2/8	5/1	9.3	-	20
Ranjith  et al[20]	2018	Regional Cancer Center Thiruvanathapuram, India	2001-2013	31	56	12/19	9/0	9	-	0
Ren et al[24]	2018	Fudan University Shanghai Cancer Center, China	2005-2017	60	61	18/42	38/22	-	-	33.35
Nusrath et al[57]	2018	Basavatakrakam Indo American Cancer Hospital, India	2010-2015	30	50	15/15	15/5	13	13 vs 36, P = 0.48	-
Sahu et al[58]	2017	Tata Memorial Hospital, India	2013-2015	37	54	25/12	-	7	-	-

¹Mean reported instead of median.

²Only cases treated with curative intent included in analysis.

³Median overall survival (OS) [abdominoperineal resection (APR) vs wide excision].

⁴APR OS grouped as lymph node negative/lymph node positive.

⁵Melanoma specific survival.

⁶Mean OS of deceased patients only.

APR: Abdominoperineal resection; WE: Wide excision; mo: Month; OS: Overall survival.