Malignant melanoma of the anus in a negro

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Abstract
On physical examination, one usually finds a nonulcerated, pigmented mass resembling a thrombosed hemorrhoid or rectal polyp. As much as half of the tumor may appear amelanotic grossly, and the tumor occasionally ulcerates. It may manifest as a large, fungating mass, or even appear as a small submucosal nodule. The diagnosis is usually made by the pathologist after histopathologic examination. A third of these tumors are amelanotic melanoma microscopically. Survival does not seem to correlate with mitotic activity or pigmentation. Malignant melanoma of the anus is a highly lethal disease. It spreads very early by way of inguinal, obturator, iliac and aortic nodes, to invade the liver, spine and lungs. Treatment varied from local excision to radical abdominoperineal resection with bilateral inguinal node dissection, as advocated by Pack and Martins. Melanoma of the anus is highly malignant, and treatment has little effect on prognosis. Surgical extirpation of the primary lesion should be carried out in hope of obtaining the rare cure and prevent obstruction. There is no evidence to support 1 form of therapy over another. Even Pack, in advocating abdominoperineal resection with bilateral groin dissection, the theoretically preferable form of treatment, states that its curative value is unpredictable and the likelihood of failure is great.