Objective Regression of Unexcised Melanoma in-Transit Metastases After Hyperthermic Isolation Perfusion of the Limbs with Melphalan

Abstract

In-transit metastases of melanoma of the limbs represent a challenging problem to the surgeon. Before the introduction of isolation perfusion, the only treatment available was major amputation, without there being evidence, however, of increased patient survival (McPeak et al. 1963; Miller 1977). Complete remissions after hyperthermic isolation perfusion with melphalan (HIPM) were reported by Stehlin et al. (1975) on some unexcised primaries and regional metastases of melanoma. However most authors (Au and Goldman 1979; Creech and Krementz 1964; Krementz and Ryan 1972; Martijn et al. 1981; Stehlin et al. 1975) have favored the policy of metastasis excision, followed or preceded by isolation perfusion. The rate of cure is between 50% and 75%, but it seems difficult to ascertain the value of adjuvant isolation perfusion because it is administered simultaneously with surgery.

We are grateful to A. Gerard, head of the Department of Surgery, for his support. M. C. Hennaut, R.N., and E. Pataschnik are acknowledged for their skillful assistance