Isolated limb perfusion for melanoma

Isolated limb perfusion with melphalan has a well-established role in the treatment of unresectable extremity melanoma manifestations. Tumour necrosis factor α (TNFα) can be added to melphalan in patients with bulky disease. Literature indicates a 54 % average complete response rate after perfusion. Additional excision, CO2 laser ablation or radiotherapy can eradicate tumour remnants in most partially responding patients. Further limb recurrence develops in approximately 44 % of the patients with a complete response, after a relatively short median interval of 5–10 months. Repeat perfusion for recurrent limb melanoma after a first perfusion frequently results in a renewed complete response. Patients with recurrent limb melanoma combined with regional lymph node metastases have an increased risk of dying within 1 year after perfusion. Adjuvant perfusion after excision of melanoma lesions may have a role in repeatedly recurring disease, since it decreases the number of recurrences and lengthens the limb recurrence-free interval significantly. Perfusion is valuable and safe in elderly patients with similar results as in younger people. When risk factors are taken into account and leakage is controlled adequately, regional toxicity and systemic toxicity after perfusion are mild. Nevertheless, considerable long-term treatment-related morbidity can occur. It has been shown that isolated limb infusion, a minimally invasive alternative to isolated limb perfusion, can also effectively and safely be used to treat advanced melanoma confined to a limb.

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