True about melanoma of the anal canal is ?

Answer is 'a' i.e. Presents usually as anal bleeding The anal canal is the third most common site for melanoma, following skin and eye. It's a rare tumor comprising less than 1% of anorectal malignancies. It is radioresistant and prognosis is very poor. Clinical presentation - average age is 50 to 60 yrs. - nonspecific symptoms are seen --3 bleeding, pain or anal mass. - usually misdiagnosed as thrombosed hemorrhoids. Treatment Melanoma is resistant to chemotherapy & radiotherapy Surgery offers the only cure but by the time the symptoms appear, the level of invasion precludes surgical cure in most patients. In these patients the disease has metastasized or is deeply invasive. A few patients presents with isolated local or locoregional disease that is potentially resectable for cure. The two surgical procedures used are - Wide local excision and - APR Recurrance is common and usually occurs systemically regardless of the initial surgical procedure. Local resection does not increase the risk of local or regional recurrance and APR offers no survival advantage over local excision. Because of the morbidity associated with APR. wide local excision is recommended for initial t/t of localized melanoma. APR may be required if the tumor involves a significant poion of the anal sphincter or is circumferential.