Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2021; 27(3): 267-280
Published online Jan 21, 2021. doi: 10.3748/wjg.v27.i3.267
Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature
Josh Bleicher, Jessica N Cohan, Lyen C Huang, William Peche, T Bartley Pickron, Courtney L Scaife, Tawnya L Bowles, John R Hyngstrom, Elliot A Asare
Josh Bleicher, Jessica N Cohan, Lyen C Huang, William Peche, T Bartley Pickron, Courtney L Scaife, Tawnya L Bowles, John R Hyngstrom, Elliot A Asare, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84114, United States
William Peche, John R Hyngstrom, Department of Surgery, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84114, United States
Tawnya L Bowles, Elliot A Asare, Department of Surgery, Intermountain Medical Center, Murray, UT 84107, United States
Author contributions: Bleicher J, Bowles TL, Hyngstrom JR and Asare EA designed the study and created the methodology; Bleicher J and Asare EA performed data analysis; Bleicher J created the first draft of the manuscript; Asare EA supervised the research; all authors participated in data acquisition and provided edits and helped with subsequent writing.
Institutional review board statement: The Institutional Review Boards of the University of Utah and Intermountain Health Care approved this study.
Conflict-of-interest statement: I confirm that I have no financial disclosures to declare. As the corresponding author for this manuscript, I also declare that none of my co-authors have financial disclosures to declare.
Data sharing statement: Because of the small number of participants involved in this cohort and the inability to obtain informed consent, it is difficult to ensure patient anonymity in our dataset and this will not be made available. Statistical code is available from the first author at
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Elliot A Asare, MD, MS, Assistant Professor, Surgical Oncologist, Department of Surgery, Huntsman Cancer Institute at the University of Utah, 1950 Circle of Hope Drive, Suite N6345, Salt Lake City, UT 84114, United States.
Received: December 1, 2020
Peer-review started: December 1, 2020
First decision: December 21, 2020
Revised: December 28, 2020
Accepted: January 7, 2021
Article in press: January 7, 2021
Published online: January 21, 2021
Research background

Anorectal melanoma (ARM) is a rare disease with poor outcomes. 5-year survival remains < 20%.

Research motivation

Optimal surgical management of ARM remains unknown. Abdominoperineal resection (APR) and wide excision (WE) are both used and no gold standard for primary tumor management currently exists. Understanding trends in management and outcomes is critical to determining appropriate surgical management.

Research objectives

We aimed to update our understanding of treatment outcomes for patients with ARM and analyze trends across countries and time.

Research methods

We performed a retrospective study of patients who were diagnosed with ARM at 7 hospitals in the Salt Lake City, UT region. We analyzed factors prognostic for recurrence and survival. We also performed a review of the literature to assess regional and temporal trends in ARM management.

Research results

We identified 24 patients diagnosed with ARM between 2000-01 and 2019-05. 12 (50.0%) had local, 8 (33.3%) regional, and 4 (16.7%) distant disease at diagnosis. Only 2 patients who had surgical resection of their primary tumor with curative intent failed to recur. Median time to recurrence was 10.4 mo [interquartile range (IQR) 7.5–17.2] and median overall survival was 18.8 mo (IQR 13.5–33.9). No patients survived to 5 years. No survival differences were noted for patients managed with WE vs APR. Review of the literature demonstrated regional trends in surgical management of ARM, with WE favored in the United States and Europe and APR used more frequently in Asia.

Research conclusions

ARM remains a highly lethal disease regardless of surgical treatment. Patients who undergo WE and APR have poor outcomes. No convincing evidence exists to favor APR over WE. Despite this, APR continues to be used for primary surgical management, although with decreasing frequency in the United States and Europe in recent years. We feel that surgical management should aim to minimize morbidity. WE should be favored over APR for primary surgical treatment.

Research perspectives

Further research should focus on better risk stratification and the role of targeted therapies, radiation therapy, and treatment sequencing. Improving non-surgical therapies will be critical to improving survival for patients with ARM.