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Gut. 2007 April; 56(4): 517.
PMCID: PMC1856835

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From the question on page 508

Endoscopic biopsies revealed malignant melanoma (fig 11).). A thoraco‐abdominal CT scan revealed mild thickening of the anorectal junction with two centimetric right femoral adenopathies. Surgical wide local excision with lymphadenectomy was performed. No histological evidence of lymphatic metastasis was found.

figure gt96982a.f1
Figure 1 The lesion is covered with a squamous epithelium presenting a junctional component and harbouring sheets of infiltrating melanocytes, with focal nesting and intra‐cytoplasmic pigmentation.

Anorectal melanomas are a very small group of mucosal melanomas with unknown aetiology and poor prognosis. They represent 1% of all melanomas and are the third most common form of melanoma. Recent epidemiologic data indicate a bimodal age distribution. To date there is no information on whether infection with the human papilloma virus plays a role in tumourigenesis. The lesions can be misdiagnosed as haemorrhoids on clinical examination.

No survival advantage has been shown for abdominoperineal resection over wide local excision. The benefit of radiotherapy after the latter is still a matter of debate. The overall 5 year survival rates range between 5% and 22% in different series.


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