Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5057
Peer-review started: December 11, 2021
First decision: January 26, 2022
Revised: February 3, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 26, 2022
Processing time: 163 Days and 23 Hours
Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases. Abdominoperineal resection was regarded as the radical procedure for disease control. Nevertheless, it led to more postoperative complications than sphincter-sparing wide local excision (WLE) and reduced the patient’s quality of life (QOL) owing to creation of colostomy. Therefore, in this study, WLE, radiotherapy (RT), and a second WLE were conducted on a patient who had been diagnosed with localized rectal melanoma.
The patient was a 79-year-old woman who had been experiencing anal pain and bloody stool for 1 mo. Colonoscopy, magnetic resonance imaging, positron emission tomography–computed tomography, and histological analysis of tissue biopsy using the histological markers Melan-A (+), S-100 (+), and Ki-67 (+, 50%) lead to the diagnosis of localized rectal melanoma. The patient had initially undergone WLE to resolve problem of anal bleeding, followed by RT to treat the residual lesion with partial response. Subsequently, the residual lesion was removed with margin-free resection by the second WLE. The patient’s postoperative course was smooth and uneventful. During the 2-year follow-up, no local recurrence was observed. Additionally, a good functional outcome and improved QOL were reported.
Combining WLE, RT, and repeat WLE is proposed as a viable alternative for treating rectal melanoma accompanied by bleeding symptoms that cannot be completely resected at the beginning.
Core Tip: Combining repeat sphincter-sparing wide excision and radiotherapy is proposed as a viable alternative to achieve negative resection margins, a lowered local recurrence, better functional outcomes, and quality of life using the least radical procedure in patients diagnosed with localized rectal melanoma.