The anorectal melanoma is a tumor with an unfavorable prognosis. The surgical removal is the therapy of choice. In the literature the different surgical centers suggest either local excision of the tumor or a more radical surgical procedure, the abdominoperineal resection either with or without inguinal and parailiacal lymph node dissection. Considering all therapeutic results the abdominoperineal resection seems to be the therapy with an advantage regarding the prognosis as the results of our own patients show. A groin lymph node dissection should only be performed if the lymph nodes are enlarged. Comparing studies which demonstrate a favorable prognostic influence of elective groin lymph node dissection are not available. Regarding the poor prognosis of the anorectal melanoma we consider an adjuvant chemo- or immunotherapy to be justified. If this will influence the clinical outcome is still a subject of discussion.