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Anorektales Melanom

Anorectal melanoma

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Zusammenfassung

Das anorektale Melanom (ARM) gehört zu den mukosalen Melanomen und ist eine aggressive Erkrankung mit einer schlechten Prognose. Das ARM wird anatomisch der Analhaut, dem anorektalen Übergang oder dem Rektum zugeordnet. Das Langzeitüberleben ist in der Regel abhängig vom Ausmaß bzw. dem Fortschreiten der systemischen Erkrankung, nicht so sehr von lokalen Rezidiven. Die chirurgische, lokale Radikalität der Behandlung hat daher in den frühen Stadien den größten Einfluss auf das Langzeitüberleben. Auch im Bereich der mukosalen Melanome haben die Targeted Therapy sowie Immuntherapie die Behandlungsmöglichkeiten erweitert und verbessert, jedoch nicht im selben Umfang wie bei kutanen Melanomen. Sie ersetzen nicht den kurativen chirurgischen Ansatz. Ob sie einen kurativen Ansatz in neoadjuvanter Intention unterstützen, ist Gegenstand aktueller Untersuchungen. Liegt eine systemische Erkrankung vor, muss sich die Chirurgie auf Eingriffe mit dem besten Organerhalt bzw. der komplikationsärmsten Symptomlinderung beschränken.

Abstract

An anorectal melanoma (ARM) is a form of mucosal melanoma and is an aggressive disease with a poor prognosis. The ARM is anatomically defined as arising from the anoderm, the anorectal junction or the rectum. Long-term survival is largely determined by the extent and progression of the systemic disease rather than locoregional recurrences. Local radical surgical treatment in the early stages therefore has the greatest impact on long-term survival. In the field of mucosal melanoma, targeted treatment and immunotherapy have also extended and improved the treatment options but have not demonstrated the same benefits as for cutaneous melanomas. They cannot replace the curative surgical approach. Whether neoadjuvant therapy will support curative surgical concepts is currently under investigation. In the presence of a systemic disease, surgery must be limited to the least invasive organ sparing procedure or the procedure with the lowest complications for the alleviation of symptoms.

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  1. Department Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland

    Hannes Philipp Neeff

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Correspondence to Hannes Philipp Neeff.

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H.P. Neeff gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Neeff, H.P. Anorektales Melanom. coloproctology 46, 3–7 (2024). https://doi.org/10.1007/s00053-023-00754-w

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