Melanoma associated with anal fissure – a literature review and case report

*Piotr Masiulaniec¹, Krzysztof Jacyna², Danuta Shafie³, Jadwiga Snarska^{1, 2}

Summary
Anal fissure is a common health problem in medical practice. This disease is characterised by a tear in the anal mucosa below the pectinate line. The incidence of this disease depends on the sex and age of the patients. The etiology of anal fissures remains unclear. The purpose of our work is to present a case of melanoma associated with anal fissure.
We present the case of a 32-year-old woman who was admitted to the Department of General Surgery for surgical treatment of anal fissure. On admission she was in a good general condition. She reported itching, burning and pain in the anus after defecation. Rectal examination in the jack-knife position revealed enlarged anoderm at 12 o’clock, covering a 1-millimetre hole with a medium-depth longitudinal area of tissue loss about 6-7 mm in length with thickened ridges, covered with granulation tissue and containing a hypertrophied papilla at the proximal pole. The skin of this region was reddened. There was no purulence on the surface or on the top of this skin lesion. A decision was made to introduce surgical treatment. The anal fissure was excised. Despite the fact that there were no macroscopic characteristics suggestive of malignancy, the collected material was sent for histopathological examination. The result: Melanoma epithelioides. The patient was referred to an oncology centre where she underwent abdominoperineal resection of the rectum. In the post-operative period parastomal hernia occurred. No decision has been made concerning further treatment using chemotherapy.
Our case report shows the need to maintain cancer vigilance during surgery and send the excised lesions for microscopic examination. It also showed that with a long duration of inflammation and the lack of appropriate therapeutic effect of conservative treatment surgical treatment should be introduced. The image of malignant melanoma can mimic various diseases, including anal fissure.

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