Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 14, 2008; 14(10): 1633-1635
Published online Mar 14, 2008. doi: 10.3748/wjg.14.1633
Melanoma of the rectum: A rare entity
PM van Schaik, MF Ernst, HA Meijer, K Bosscha
PM van Schaik, MF Ernst, K Bosscha, Jeroen Bosch Hospital, Department of Surgery, ’s-Hertogenbosch 5211, The Netherlands
HA Meijer, Jeroen Bosch Hospital, Department of Pathology, ’s-Hertogenbosch 5211, The Netherlands
Correspondence to: PM van Schaik, Jeroen Bosch Hospital, Nieuwstraat 34, NL ’s-Hertogenbosch 5211, The Netherlands. pvanschaik@hotmail.com
Telephone: +31-73-6992701
Fax: +31-73-6992163
Received: August 22, 2007
Revised: January 6, 2008
Published online: March 14, 2008
Abstract

A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidoscopy, which proved to be a leiomyosarcoma upon biopsy. Dissemination studies did not show any metastases. He was underwent to an abdomino-perineal resection (APR). Histopathology of the specimen showed a melanoma (S-100 stain positive). Two years after the resection, metastases in the abdomen and right lung were found. He died one and half years later. Primary anorectal melanoma is a rare and very aggressive disorder. According to current data, one should always perform a S-100 stain when anorectal sarcoma is suspected. A positive S-100 stain suggests the tumour to be most likely a melanoma. Subsequently, thorough dissemination studies need to be performed. Depending on the outcome of the dissemination studies, a surgical resection has to be performed. Nowadays, a sphincter-saving local excision combined with adjuvant loco-regional radiotherapy should be preferred in case of small tumors. The same loco-regional control is achieved with less “loss of function” compared to non-sphincter saving surgery. Only in the case of large and obstructing tumors an abdomino-perineal resection is the treatment of choice.

Keywords: Melanoma; Rectum; Abdomino-perineal resection; Cancer; Surgery