Surgical treatment of the surrounding lymph node areas remains a

Surgical treatment of the surrounding lymph node areas remains a controversial topic. It was initially thought that lymph node dissection at the time of surgery was essential given the high rate of lymph node involvement with anorectal melanoma. It was thought that observation of lymph nodes until they were clinically suspicious would potentially miss a curative window of opportunity. However, several studies performed did not find a difference in overall survival with upfront mesenteric lymph

node dissection. Higher rates of lymphedema and perioperative morbidity were seen with lymph node dissection (11,16). Despite attempts at curative surgery in patients with anorectal Inhibitors,research,lifescience,medical melanoma, the median survival is still dismal at less than 20 months (17). Accordingly, quality of life considerations must be taken into account. The surgical approach chosen should strive to find a balance between achieving local control and avoiding perioperative morbidity. Disseminated metastatic disease is seen in as many as one third of anorectal Inhibitors,research,lifescience,medical melanoma patients at the time of disease presentation (18). The role of systemic therapy is not well established Inhibitors,research,lifescience,medical in this disease. Many agents have been employed in treating systemic melanoma. They

include vincristine, dacarbazine, nimustine, cisplatin, and interferon. Inhibitors,research,lifescience,medical None of these have demonstrated a significant survival benefit in treating anorectal melanoma (19-21). The timing of systemic therapy is also unclear. Some advocate the use

of systemic therapy in a palliative setting only while others advocate its use in the adjuvant setting. Biochemotherapy, a method of administering both a biologic and chemotherapeutic agent, has been used to successfully treat some cases of cutaneous melanoma (22). One series investigating biochemotherapy Inhibitors,research,lifescience,medical did show 44% good disease response which is higher than any documented individual chemotherapy series (23). Systemic interferon is another frequently used systemic therapy for melanoma. Interferon-α has shown antineoplastic effects related to a number of direct and indirect immune-modulating effects. One case study did no demonstrate complete pathologic response of primary anorectal melanoma and near complete response of associated pulmonary metastases after combined interferon and dacarbazine administration (24). Data with systemic treatment is limited in the literature but these are encouraging findings which support buy PS-341 further investigation into combined, multi-agent systemic therapies. The role of radiation therapy in anorectal melanoma has largely been relegated to post-operative or palliative settings. One study demonstrated a local control rate similar to APR when radiation was given to the primary site after WLE. However, there was no difference in survival (25).

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