Isolated regional perfusion in malignant melanoma of the extremities

Isolated perfusion for regional chemotherapy is only practical for tumors located on the extremity, because this is the only site where adequate vascular occlusion can be achieved. Indications for perfusion in clinical stage I melanoma patients are determined by microstaging of the tumor. At our institution, patients with Clark's levels III, IV, or V and a Breslow thickness of ≥1.5 mm are eligible. Lower limb perfusions are started through an iliac perfusion. Two perfusions are performed for foot lesions, local recurrences, satellitosis, or intransit metastases. Flow rates for leg perfusion vary from 600 to 1,000 ml/min. During the past few years, higher flows (up to about 1,200 ml/min) have been utilized. Less toxicity developed with better tissue perfusion, and the dosage of cytostatics could be increased. The dosage of cytostatic drugs is calculated by limb volume, as determined by immersion in water. In our opinion, hyperthermia yields superior results for cases of local recurrence or intransit métastases. It is not known if a combination of cytostatic drugs might improve results compared to a single drug.