Treatment patterns of anal melanoma in the era of immunotherapy

Hannah E Sofield; Sara H Buchner; Rachel J Nation; T N Hess; Gena V Topper; Matthew C Moccia; John Epoh Dibato; Michael E Kwiatt; Steven J McClane; Danica N Giugliano; Francis R Spitz; Young K Hong; Madeline B Torres

doi:10.1016/j.amjsurg.2025.116658

Treatment patterns of anal melanoma in the era of immunotherapy

Am J Surg. 2025 Dec:250:116658. doi: 10.1016/j.amjsurg.2025.116658. Epub 2025 Oct 10.

Authors

Affiliations

¹ Department of Surgery, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, United States.
² Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States.
³ Department of Surgery, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, United States; Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States.
⁴ Department of Surgery, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, United States; Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States; MD Anderson Cancer Center at Cooper University Hospital, 2 Cooper Plaza, Camden, NJ, 08103, United States.
⁵ Department of Surgery, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ, 08103, United States; Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States; MD Anderson Cancer Center at Cooper University Hospital, 2 Cooper Plaza, Camden, NJ, 08103, United States. Electronic address: torres-madeline@cooperhealth.edu.

PMID: 41108887
DOI: 10.1016/j.amjsurg.2025.116658

Abstract

Background: Anal melanoma (AM) is a rare and aggressive cancer with poor survival and absence of standard treatment guidelines.

Methods: This study analyzed 762 cases of AM from the National Cancer Database during 2004-2021. The primary objectives were to evaluate treatment patterns and survival outcomes before and after the FDA approval of immunotherapy (IT) in 2011.

Results: The use of IT increased significantly after 2011 in patients with stage IV AM (14 %-58 %). Abdominoperineal resection (APR) rates declined post-IT (49 %-31 %, p < 0.0001), in both community and academic centers. For patients treated with IT, median overall survival for stage III rose from 20.3 to 27.2 months (p = 0.0057) and nearly doubled for stage IV (6.7-13.3 months, p < 0.0001). No survival benefit was observed in earlier stages (p = 0.5712).

Conclusions: IT use in advanced AM is increasing, correlating with longer survival and reduced APR rates in later stage patients.

Keywords: APR; Abdominoperineal resection; Anal; Cancer; Immunotherapy; Melanoma; Survival.

MeSH terms

Adult
Aged
Aged, 80 and over
Anus Neoplasms* / mortality
Anus Neoplasms* / pathology
Anus Neoplasms* / therapy
Female
Humans
Immunotherapy*
Male
Melanoma* / mortality
Melanoma* / pathology
Melanoma* / therapy
Middle Aged
Neoplasm Staging
Proctectomy / statistics & numerical data
Retrospective Studies
Survival Rate
United States