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A Rare Case of Primary Anorectal Melanoma and a Review of the Current Landscape of Therapy
Gupta, Brinda Kamat, Bhishak
Gupta, Brinda
Kamat, Bhishak
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Journal article
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2020-08-02
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Medicine
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https://doi.org/10.1080/20009666.2020.1787809
Abstract
Introduction: Anorectal mucosal melanoma (ARMM) is an uncommon and highly aggressive malignancy. Given its rarity, there is insufficient evidence on the optimal medical management which presents as a clinical challenge to its diagnosis and treatment. Treatment of ARMM typically involves a multimodal approach including surgical resection, chemotherapy, targeted therapy and/or immunotherapy. Case Presentation: Here, we present a case of a 78-year-old female who presented with a four-month history of rectal bleeding and bowel incontinence. Ultimately, colonoscopy revealed a mass at the anal verge, and biopsy of the mass showed malignant cells that stained positive for S100, Melan-A and HMB-45, consistent with the diagnosis of malignant melanoma. Molecular testing revealed no BRAF, KIT or NRAS gene mutations. PD-L1 immunohistochemistry showed tumor proportion score of 1%. She underwent abdominoperineal resection with a plan to initiate immunotherapy with an anti-PD-1 checkpoint inhibitor. This case highlights a rare aggressive malignancy and reviews its treatment option, which are mostly extrapolated from its cutaneous counterpart and some derived from a few case reports. Due to its rarity, there is no consensus guideline for the treatment of ARMM.
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Ho-Man Yeung, Brinda Gupta & Bhishak Kamat (2020) A Rare Case of Primary Anorectal Melanoma and a Review of the Current Landscape of Therapy, Journal of Community Hospital Internal Medicine Perspectives, 10:4, 371-376, DOI: 10.1080/20009666.2020.1787809
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Taylor & Francis Open Access
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Journal of Community Hospital Internal Medicine Perspectives, Vol. 10, 2020, Issue 4
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