Primary Anorectal Malignant Melanoma Successfully Treated with Local Excision and Immunochemotherapy ∼A Case Report∼

Kazuhito Tsuchida¹⁾, Katsuya Yoneyama¹⁾, Kazuyoshi Sasaki¹⁾³⁾, Yasuyuki Jin¹⁾³⁾, Akio Kasahara¹⁾, Takeshi Kabara²⁾³⁾, Hiroyuki Iwasaki²⁾, Takayuki Kosuge³⁾, Yasushi Rino³⁾ and Yoji Nagashima⁴⁾

Department of Surgery, Kanagawa Prefectural Ashigara-kami Hospital¹⁾
Department of Surgery, International University of Health and Welfare, Atami Hospital²⁾
First Department of Surgery³⁾ and Department of Pathology⁴⁾, Yokohama City University School of Medicine

Anorectal malignant melanoma is rare, has no established therapeutic regimen, and suggests a generally unfavorable prognosis. We report such a case treated successfully with local resection followed by chemotherapy and immunotherapy. A 65-year-old woman with anal bleeding was found on physical examination to have two pedunculated black polyps at 8° on the wall of the anorectum, histologically diagnosed as malignant melanoma after transanal polypectomy. The tumors were a maximally 7 mm thick and invasion was limited to the submucosa. Tumor cells apparently involved the cut margin in spite the absence of nodal and visceral metastasis. After chemotherapy and immunotherapy, follow-up biopsy showed residual melanoma cells around the polypectomy stump. Despite additional wide local excision, histological examination failed to reveal residual malignant melanoma cells. After surgery, we conducted immunochemotherapy again and the woman remains well without any sign of recurrence in the more than 6 years following surgery. This successfully case of anorectal melanoma provides valuable information on establishing an effective therapeutic regimen for this disease.

Key words
anorectal malignant melanoma, long time survival, therapeutic regimen

Reprint requests
Kazuhito Tsuchida Department of Surgery, International University of Health and Welfare, Atami Hospital
13-1 Higashikaigancho, Atami, 413-0012 JAPAN

Accepted
May 25, 2004

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