PRIMARY ANORECTAL MELANOMA - A SERIES OF 19 CASES

Objective : The aim of this study was to determine the significant pro gnostic factors for primary anorectal melanoma and propose a standard surgical procedure. Patients and methods : From 1975 to 1995, 19 patie nts with primary melanoma of the anus were treated. Five patients were given palliative care, 6 had abdominoperineal amputation and 8 had cu rative local transrectal tumoral excision, Two patients also underwent inguinal node dissection. Results: Overal 5-year survival was 22 %. U nivariate analysis skewed a significantly poorer prognosis when : ingu inal or pelvic nodes were invaded (p = 0.01), surgical margins were in vaded (p = 0.003), visceral metastases were present (p = 0.01) and the tumor measured over 20 mm thick (p = 0.01). Prognosis was unchanged b y the type of surgical exeresis. Conclusions: Local transrectal excisi on is the first ling choice for primary anorectal melanoma. Amputation of the rectum should be reserved for cases where complete tumor resec tion is technically impossible transrectally. Node dissection is indic ated in cases with clinical invasion of the inguinal nodes.