Clinicopathological Profile and Outcomes of Anorectal Melanoma From a Tertiary Care Center in India

Figures & data

Table 1. Baseline characteristics of patients with anorectal melanoma.

Parameter	n = 27 (%)
Median age (years)	57 (26–80).
Male/female	19/8 (70.4% males)
Median symptom duration (months)	4 (1–12)
Presenting symptoms Anorectal mass Bleeding per rectum Perianal pain Constipation Weight loss Fatigue Diarrhea Loss of appetite Inguinal mass	19 (70.4%) 19 (70.4%) 18 (66.6%) 11 (40.7%) 8 (29.6%) 2 (7.4%) 2 (7.4%) 2 (7.4%) 1 (3.7%)
Location of primary tumor Anal canal Anorectal Rectal	10 (37.0%) 8 (29.6%) 9 (33.3%)
Ballantine staging Stage 1 Stage 2 Stage 3	6 (22.2%) 9 (33.3%) 12 (44.4%)
Depth of invasion Mucosa Submucosa Muscularis Not known	0 4 (14.8%) 18 (66.6%) 5 (18.5%)
Pigmentation Amelanotic Melanotic	15 (55.5%) 12 (44.4%)
Lymph node involvement	18 (66.6%)
Distant metastasis Liver Lung Bones	8 (29.6%) 6 (22.2%) 1 (3.7%)

Table 2. First line of management in patients with anorectal melanoma.

Treatment modality	n = 27 (%)
First-line treatment Surgery Palliative chemotherapy Best supportive care Chemoradiation Observation	13 (48.1%) 9 (33.3%) 3(11.1%) 1 (3.7%) 1 (3.7%)
Initial surgery (n = 13) APR WLE Others ^†	6 (46.1%) 4 (30.8%) 3 (23.1%)
Adjuvant chemotherapy	1 (3.7%)
Adjuvant radiotherapy	2 (7.4%)
Palliative radiotherapy	6 (22.2%)
First-line palliative chemotherapy Dacarbazine Immunotherapy Taxane ^‡	5 (18.5%) 2 (7.4%) 2 (7.4%)

† Surgery done considering hemorrhoidectomy.

‡ Nab-paclitaxel and docetaxel in one patient each.

APR: Abdomino-perineal resection; WLE: Wide local excision.

Figure 1. Kaplan–Meier curve showing overall survival in study population at median follow-up time of 11 months (range: 1–36 months).

OS: Overall survival.

Figure 2. Kaplan–Meier curve showing overall survival with stage.

Median overall survival was 37, 30 and 18 months in stage I, II and III, respectively.

Table 3. Characteristics and management at time of relapse in anorectal melanoma.

Parameter	n = 9 (%)
Median time to relapse	21 months (7 months – not reached)
Sites involved at time of relapse Local ^† Lymph nodes Lung Liver Bones Peritoneal/omental Others (pancreas, spleen, brain, urinary bladder)	7 (77.7%) 6 (66.6%) 6 (66.6%) 5 (55.5%) 4 (44.4%) 2 (22.2%) 1 (11.1%)
Treatment at relapse Palliative chemotherapy Observation WBRT Surgery Best supportive care	4 (44.4%) 2 (22.2%) 2 (22.2%) 1 (11.1%) 1 (11.1%)

† Local only relapse in one patient.

WBRT: Whole brain radiotherapy.

Figure 3. Kaplan–Meier curve showing probability of relapse following surgery in anorectal melanoma.

Median time to relapse after surgery was 21 months (7 months – not reached).

Figure 4. Kaplan–Meier curve showing probability of relapse following wide local excision and abdomino-perineal resection in anorectal melanoma.

Median time to relapse was 33 months with WLE and 7 months with APR.

APR: Abdomino-perineal resection; WLE: Wide local excision.