title: [Anorectal malignant melanoma : Treatment recommendations].
abstract: BACKGROUND
  Anorectal malignant melanoma is a rare tumor with a poor prognosis. Typical symptoms (bleeding, pain, perianal mass) are characteristic of hemorrhoids. This, together with the high rate of amelanotic tumors, often delays diagnosis. No therapy guidelines exist.
  
  
  METHODS
  Based on our own experience of surgically treated patients and an extensive literature search, we present a stage-dependent therapeutic concept.
  
  
  RESULTS
  Eight patients (six women) with a mean age of 65 ± 8 years were treated at our institution. Six underwent abdominoperineal resection; two had local excision. Two patients additionally underwent inguinal lymph node dissection. Median survival was 12 months with a disease-free survival of 6 months. Forty treatment studies with a total of 1,970 cases could be identified. Prognostic factors are age, time to correct diagnosis, tumor extent, tumor stage, and perineural invasion. The impact of lymph node metastases and R0 resection varies. Surgery is the only effective therapy. Local excision is sufficient when free resection margins are achieved.
  
  
  CONCLUSIONS
  Locally limited tumors should be resected; if possible using local excision. Larger tumors or tumors with sphincter infiltration often require abdominoperineal resection with curative intent. When regional lymph node metastases are present, we advise regional lymphadenectomy of the affected area. In the case of distant metastases, palliative surgery is needed for metastasectomy and in cases of incontinence or refractory pain.
authors.affiliation: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Deutschland. tim.glowka@ukb.uni-bonn.de.
authors.forename: T R
authors.initials: TR
authors.lastname: Glowka
authors.affiliation: Frauenklinik, Abteilung für Frauenheilkunde und Gynäkologische Onkologie, Universitätsklinikum Bonn, Bonn, Deutschland.
authors.forename: M D
authors.initials: MD
authors.lastname: Keyver-Paik
authors.affiliation: Institut für Pathologie, Universitätsklinikum Bonn, Bonn, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Thiesler
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Landsberg
authors.affiliation: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Deutschland.
authors.forename: J C
authors.initials: JC
authors.lastname: Kalff
authors.affiliation: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Pantelis
mesh_terms: D000368:Aged; D001005:Anus Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*
keywords: Abdominoperineal resection; Anorectal; Melanoma; Perianal neoplasms