Wide local excision or abdominoperineal resection as the initial treatment for anorectal melanoma?

Background: Anorectal melanoma (AM) is a rare tumor with a poor prognosis. Treatment with abdominoperineal resection (APR) over wide local excision (WLE) is still debated. This study aimed to compare median survival of WLE and APR in patients with AM. Methods: A systematic review of the literature was performed. Only series that allowed calculation of median survival were included. Results: Fourteen studies met inclusion criteria. Average median survival of stage I WLE patients (N = 34) and stage I APR patients (N = 31) was 44 and 22 months, respectively (P = .001). For stage II patients, 7 underwent WLE, and 10 underwent APR with an average median survival of 36 and 14 months, respectively (P = .19). Conclusions: This study identified no stage-specific survival advantage to APR in favor of AM. Given that WLE is a more limited intervention associated with at least comparable survival, we propose that it be considered the initial treatment of choice for AM.