Li Zhihao, Šandera Peter, Beer Marc, Weber Markus
Department of Visceral, Thoracic, Vascular Surgery, Municipal Hospital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland.
Department of Pathology, Municipal Hospital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland.
BMC Surg. 2020 Apr 7;20(1):68. doi: 10.1186/s12893-020-00727-6.
Primary anorectal melanoma can be a rare differential diagnosis of anorectal mass. Due to the low case number reported in the literature, physicians are not aware of this aggressive disease. Although no consensus exists, wide local excision and abdominoperineal resection are considered the mainstay therapy.
An 85-year-old female patient presented with fecal incontinence 5 years after local resection of a primary anorectal melanoma. In the rectoscopy, a tumor proximal to the dentate line was identified and later confirmed as a recurrent primary anorectal melanoma. There were no signs of locoregional or distant metastasis on the MRI and PET/CT. She underwent another wide local excision and regained fecal continence postoperatively.
Primary anorectal melanoma should belong to the differential diagnosis of anorectal mass. If technically feasible, wide local excision represents a less invasive treatment than abdominoperineal resection, retaining the anal sphincter and patient's quality of life. Even though wide local excision has a higher recurrence rate than abdominoperineal resection, there is no difference in survival between the two procedures. This is only under the premise that patients are followed-up regularly after wide local excision so that recurrence can be spotted early on and locally excised.
原发性肛管直肠黑色素瘤是肛管直肠肿物一种罕见的鉴别诊断。由于文献报道的病例数较少，医生对这种侵袭性疾病并不了解。尽管尚无共识，但广泛局部切除和腹会阴联合切除术被认为是主要治疗方法。
一名85岁女性患者在原发性肛管直肠黑色素瘤局部切除术后5年出现大便失禁。在直肠镜检查中，发现齿状线近端有一个肿瘤，后来证实为复发性原发性肛管直肠黑色素瘤。MRI和PET/CT检查未发现局部或远处转移迹象。她接受了另一次广泛局部切除，术后恢复了大便失禁。
原发性肛管直肠黑色素瘤应列入肛管直肠肿物的鉴别诊断。如果技术上可行，广泛局部切除是一种比腹会阴联合切除术侵入性更小的治疗方法，可保留肛门括约肌和患者的生活质量。尽管广泛局部切除的复发率高于腹会阴联合切除术，但两种手术的生存率并无差异。这仅在广泛局部切除术后对患者进行定期随访以便早期发现复发并进行局部切除的前提下成立。
