title: Anorectal malignant melanoma: curative abdominoperineal resection: patient selection with 18F-FDG-PET/CT.
abstract: BACKGROUND
  Anorectal malignant melanomas (ARMM) are rare tumors, characterized by an early lymphatic spread and distant metastasis, resulting in an extremely poor overall survival. The objective of this study was to determine the pattern of regional lymph node metastasis (LNM) by computed tomography (CT) and 18F-FDG-PET/CT in patients undergoing abdominoperineal resection (APR) and its impact on oncologic outcome.
  
  
  METHODS
  A retrospective analysis of six consecutive patients who underwent APR due to primary ARMM was performed. Patients were staged by CT and PET/CT.
  
  
  RESULTS
  Four out of six patients had preoperative LNM involvement (two patients inguinal and perirectal, one iliacal, one perirectal), with two of them presenting with distant metastases additionally. Inguinal/iliacal LNM in two patients as well as liver metastasis in one patient was seen in PET/CT and missed by CT. The three patients with initial inguinal/iliacal LNM died during the observation period (overall survival: 10 (6-18) months). The three patients without inguinal/iliacal LNM involvement are currently alive, one patient showing a slowly progressive disease since 5 years, and two patients are tumor-free since 8.5 and 1.5 years (the patients had initial perirectal LNM).
  
  
  CONCLUSIONS
  In ARMM, PET/CT is superior to CT in detection of LNM and distant metastasis. APR is possibly a curative approach if the PET/CT shows exclusively perirectal LNM despite locally advanced tumor growth.
authors.affiliation: Department of Surgery and Transplantation, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. claudius.falch@gmx.de.
authors.forename: Claudius
authors.identifier: http://orcid.org/0000-0003-1595-7422
authors.initials: C
authors.lastname: Falch
authors.affiliation: Department of Surgery and Transplantation, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Department of Surgery and Transplantation, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kirschniak
authors.affiliation: Department of Surgery and Transplantation, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Braun
authors.affiliation: Department of Surgery and Transplantation, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Alfred
authors.initials: A
authors.lastname: Koenigsrainer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Klumpp
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery; D001005:Anus Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Abdominoperineal resection; Anal melanoma; Anus neoplasms; Colorectal surgery; Computed tomography; PET; Rectal melanoma