Primary Anorectal Malignant Melanoma:Diagnosis Treatment Analysis And Related Literature Review

Primary anorectal malignant melanoma(PARMM)is a malignant tumor formed by malignant transformation of melanocytes in the rectum-anal canal.Malignant melanoma is considered to be a tumor derived from ectoderm neural ridge cells.In recent years,the overall incidence of primary anorectal malignant melanoma is increasing year by year.At present,the incidence of this tumor is about 0.5%-1.6% in malignant melanoma,which is low rectal and anal canal.The incidence of regional malignancies ranges from 0.05%-4.6%.Because the low rectal and anal canal sites are relatively concealed,there is no specific clinical symptoms in the early stage,the rate of misdiagnosis is high,and the degree of malignancy is extremely high.Currently,there is no standard standard of diagnosis and treatment in the world.In order to improve the understanding,diagnosis and treatment of the disease among medical workers,and to reduce the rate of misdiagnosis,this paper collects patients who have been diagnosed as anorectal malignant melanoma and treated with surgery in the Fourth Hospital of Hebei Medical University from 2013 to 2018.Experience and deficiencies in the diagnosis and treatment process,and refer to relevant reports and literature,and learn together.Objective: To summarize the clinical features and treatment results of patients with primary anorectal malignant melanoma,and to analyze the clinical literature and diagnosis and treatment of anorectal malignant melanoma.Methods: Twelve patients who were diagnosed as anorectal malignant melanoma and treated with surgery in the Fourth Hospital of Hebei Medical University from 2013 to 2018 summarized the clinical features,treatment methods and postoperative survival of the patients,and referred to relevant literature at home and abroad.The report was retrospectively analyzed to assist in the diagnostic analysis of the disease.Results: A total of 12 patients with primary anorectal malignant melanoma who underwent surgery in our hospital were enrolled.The age span was 50-79 years old,and the median age was 60.5 years.All patients were older than 50 years old,and 58.3% of patients were included.Over 60 years old.The main clinical manifestations of the disease are: blood in the stool,anal irritation or urgency and anal sag,diarrhea and mass prolapse.In 75% of patients,blood is the main clinical symptom,and the average distance of the tumor from the anal margin is about 2.67 cm.The specific immunohistochemical indexes were: S-l00 protein,HMB-45,Melan-A/MART-1 and Vimentin,Ki67.The positive proportion of all four indicators was 41.7%,S-l00 protein The proportion of positive HMB-45 was 66.7%;the ratio of Ki-67 was higher than 50%,which was about 18.2%.All patients underwent surgical treatment,and approximately 25% of patients underwent routine adjuvant therapy(biological immunotherapy-cytokine activation of killer cells).The average disease-free survival was about 25.9 months,the 2-year disease-free survival rate was about 41.7%,and the 3-year disease-free survival rate was about 33.3%.The average disease-free survival of patients in stage I was approximately 31.6 months,and the average disease-free survival of stage II patients was approximately 16.4 months.Conclusions:PARMM is a malignant tumor with a low overall incidence and poor prognosis.No specific clinical manifestations,pathological and immunohistochemistry have been clearly diagnosed.At present,surgery and multidisciplinary comprehensive treatment are the main treatment methods for this disease.Patients with earlier staged procedures are preferred for surgical treatment.Patients with advanced stage require comprehensive treatment and surgical treatment.Immunotherapy combined with targeted therapy can significantly improve the therapeutic effect of the disease.