Should Abdominoperineal Excision Be Considered as the Initial Treatment for a Primary Anorectal Malignant Melanoma?

five-year disease-specific survival for the entire cohort was 34%, with a median follow-up of 39 months for survivors. Thirty-four (74%) of 46 patients relapsed, with a median relapse-free survival of 10 months and an overall recurrence rate of 53% at 1 year. The majority of patients developed distant recurrences. No differences were seen in patterns of relapse between patients treated with an APR or a LE: 5 of 19 (26%) patients in the APR group and 7 of 27 (26%) in the LE group developed local recurrence as the first site of relapse. Survival was similar in both groups, with 5-year disease-specific survivals of 32% for the APR group and 35% for the LE group. These findings suggest that local recurrence and survival in patients with an anorectal melanoma are not associated with the extent of resection. A systematic review that included 14 series also showed no stagespecific survival advantage for the APR [2]. Recently Nilsson and Ragnarsson-Olding [3] reported that there was no statistically significant difference in terms of median survival (11 months vs. 14 months) or the five-year survival rate (7% vs. 15%) between patients treated with the APR or the LE (P = 0.084). When 72 patients in whom a R0 resection had been achieved were compared with patients having involved margins (R+), there was a significant difference in survival in favor of the R0 resection; thus, both the APR and the LE seemed appropriate for treating an anorectal melanoma, provided clear margins could be achieved. Because of the APR having no survival advantage over the LE and because of the poor prognosis associated with an anorectal melanoma, further consideration must be given to quality-of-life issues when making treatment decisions between these two treatment options.