2010 Volume 9 Issue 3 Pages 244-249
A 63-year-old woman who had noticed occasional melana over 5 months demonstrated a black-brown colored and irregular macule on the perianal region that was initially detected by another hospital. She was referred to our department for further examination under a suspicion of melanoma in situ. In addition to perianal irregular pigmentation, a colonoscopic examination showed an irregular-shaped red-to-brownish nodule with white moss on the surface and irregular pigmentation of the bottom over the dentate line. The lesion was 18mm in diameter and histologically diagnosed as the mucosal type of malignant melanoma based on concurrent mucosal biopsy. Since 18F-FDG PET CT scan suggested metastases to the right obturator lymph nodes but not to distant organs, rectal amputation with extensive lymph node dissection was performed. Tumor thickness of the resected melanoma was 16mm and the post-surgical stage was pT4bN3aM0, Stage IIIA, according to AJCC 2002. Sequentially, the patient received adjuvant chemotherapy with DTIC, CDDP, with the addition of oral Tamoxifen, which is an antagonist of estrogen receptor. Recent reports show that estrogen receptor is expressed in melanoma and its signaling may be associated with the growth of melanoma cells. Because 10-20% of tumor cells in the present case were positive for estrogen receptor, an antagonist of estrogen receptor was diurnally administered. We present a case of advanced melanoma arising in both the anal and rectal regions and discuss the clinical effect of hormone receptor antagonist on malignant melanoma with estrogen receptor expression.Skin Research, 9: 244-249, 2010
