Anal Melanoma
Anal Melanoma
Anal melanoma is a devastating malignancy easily confused with benign hemorrhoids. Physician unfamiliarity with this bleeding rectal lesion can lead to delays in diagnosis and therapy. Four cases of anal melanoma, all initially mistaken for hemorrhoids, have been documented in the past 4 years at our institution. Despite surgical intervention and chemoimmunotherapy, each patient succumbed to widely metastatic disease. Average survival was 15.2 months. The clinical, pathologic, surgical, and oncologic features of anal melanoma are reviewed to enhance physician recognition of this unusual anorectal disorder.
Hemorrhoids are the most frequently diagnosed anorectal lesion and the most common cause of rectal bleeding. Up to 50% of the adult population in the United States may be affected. Typical symptoms are pain, pruritus, bleeding, and prolapse. Conservative therapies may provide symptomatic relief, while surgical techniques such as rubber band ligation, sclerotherapy, electrocoagulation, and hemorrhoidectomy allow definitive resolution. In the past 4 years at our institution, four cases have been encountered in which apparent hemorrhoids refractory to conservative management were subsequently diagnosed as anal melanoma. This alarming disease is rarely considered in patients thought to have benign, common hemorrhoids and carries a grave prognosis. While surgical and oncologic publications pertaining to anal melanoma are numerous, only one article is available for primary care clinicians who, in our opinion, are often unaware of the significance of this neoplasm. We present four cases ( Table ).
Abstract and Introduction
Abstract
Anal melanoma is a devastating malignancy easily confused with benign hemorrhoids. Physician unfamiliarity with this bleeding rectal lesion can lead to delays in diagnosis and therapy. Four cases of anal melanoma, all initially mistaken for hemorrhoids, have been documented in the past 4 years at our institution. Despite surgical intervention and chemoimmunotherapy, each patient succumbed to widely metastatic disease. Average survival was 15.2 months. The clinical, pathologic, surgical, and oncologic features of anal melanoma are reviewed to enhance physician recognition of this unusual anorectal disorder.
Introduction
Hemorrhoids are the most frequently diagnosed anorectal lesion and the most common cause of rectal bleeding. Up to 50% of the adult population in the United States may be affected. Typical symptoms are pain, pruritus, bleeding, and prolapse. Conservative therapies may provide symptomatic relief, while surgical techniques such as rubber band ligation, sclerotherapy, electrocoagulation, and hemorrhoidectomy allow definitive resolution. In the past 4 years at our institution, four cases have been encountered in which apparent hemorrhoids refractory to conservative management were subsequently diagnosed as anal melanoma. This alarming disease is rarely considered in patients thought to have benign, common hemorrhoids and carries a grave prognosis. While surgical and oncologic publications pertaining to anal melanoma are numerous, only one article is available for primary care clinicians who, in our opinion, are often unaware of the significance of this neoplasm. We present four cases ( Table ).