Anorectal melanoma (AM) is a rare tumor with a poor prognosis. Treatment with abdominoperineal resection (APR) over wide local excision (WLE) is still debated. This study aimed to compare median survival of WLE and APR in patients with AM. A systematic review of the literature was performed. Only series that allowed calculation of median survival were included. Fourteen studies met inclusion criteria. Average median survival of stage I WLE patients (N = 34) and stage I APR patients (N = 31) was 44 and 22 months, respectively (P = .001). For stage II patients, 7 underwent WLE, and 10 underwent APR with an average median survival of 36 and 14 months, respectively (P = .19). This study identified no stage-specific survival advantage to APR in favor of AM. Given that WLE is a more limited intervention associated with at least comparable survival, we propose that it be considered the initial treatment of choice for AM.