Published in:
01-07-2020 | Proctoscopy | The Last Image
A dark swelling in a hidden place
Published in: Techniques in Coloproctology | Issue 7/2020
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A previously healthy 79-year-old man was referred to our surgical department with a 2-month history of a dark looking perianal swelling without other local or systemic symptoms. Proctoscopy revealed a 2 × 2 cm tumor (Fig. 1). Histopathologic evaluation (Fig. 2) confirmed a diagnosis of ulcerated primary anorectal melanoma (PARM): pT4b, pNx, LVI1, Pn1, Breslow’s depth 0.8 cm. Further imaging (positron-emission tomography-computed tomography and magnetic resonance imaging) showed diffuse metastases to the lungs and inguinal lymph nodes without central nervous system invasion. Immunotherapy was prescribed.
Fig. 1
Intraoperative funding
Figure 2
a Overview, b perineural invasion, c, d immunohistochemistry with Melan A, e ulceration, f angioinvasion
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