Quinn Rakesh, Ellis-Clark Jodie
Department of Colorectal Surgery, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia.
J Surg Case Rep. 2024 Aug 3;2024(8):rjae477. doi: 10.1093/jscr/rjae477. eCollection 2024 Aug.
Anorectal mucosal melanoma is rare entity. There is currently no consensus on optimal surgical treatment for loco-regional anorectal melanoma that has a favourable outcome. Abdominoperineal resection has not shown a survival benefit over wide local excision due to the inevitable distant recurrence. With local excision considered favourable given reduced surgical morbidity and avoidance of permanent stoma. However, anorectal melanomas are often diagnosed late, with an increased tumour size and depth of primary lesions, increasing the risk of local recurrence and subsequent disease morbidity when excised locally. The decision to proceed to local excision versus abdominoperineal resection is complex, it needs to be individualized, based on primary tumour clinicopathological features and driven by multidisciplinary discussion, with the goal to improve quality and quantity of life. We present a case of a 66-year-old female with anorectal mucosal melanoma with locoregional disease and our surgical approach.
肛管直肠黏膜黑色素瘤是一种罕见的疾病。目前对于局部区域的肛管直肠黑色素瘤，尚无关于能带来良好预后的最佳手术治疗方案的共识。由于不可避免的远处复发，腹会阴联合切除术相较于广泛局部切除术并未显示出生存获益。鉴于手术并发症减少且避免了永久性造口，局部切除术被认为是有利的。然而，肛管直肠黑色素瘤往往诊断较晚，原发肿瘤大小增加且病变深度加深，这增加了局部切除后局部复发及后续疾病并发症的风险。决定进行局部切除还是腹会阴联合切除术很复杂，需要根据原发肿瘤的临床病理特征进行个体化决策，并通过多学科讨论来推动，目标是提高生活质量和延长生存期。我们报告一例66岁患有局部区域疾病的肛管直肠黏膜黑色素瘤女性患者及我们的手术方法。
