Prognostic factors for survival after isolated limb perfusion for malignant melanoma

Aims: Risk factors were determined for mortality within 1 year after isolated limb perfusion (ILP). Methods: All of 439 patients who underwent ILP for melanoma of the extremities were studied. Ninety percent of the patients had MD Anderson stage IIB or III disease at the time of ILP. ILP was performed with melphalan with or without TNFα under mild hyperthermic (38-40 °C) or normothermic (37-38 °C) conditions in 80% of the cases. Results: Sixty-nine patients died within this period, 64 of metastatic melanoma. The indication for ILP was an unresectable primary (n = 3), a local recurrence (n = 24) or adjuvant to excision of primary lesions (n = 17) in patients with stage IIIB regional lymph node metastases. These patients or patients with stage IIIAB melanoma with satellites and/or in-transit metastases with regional lymph node metastases had a relative risk of 4.6 (95% CI 2.0-6.6) and 3.6 (95% CI 2.1-10) of dying within 1 year from ILP, respectively (p < 0.001). In patients with stage IV disease (distant metastases), the relative risk was 22 (95% CI 3.8-127, p = 0.001). Conclusion: Patients with advanced limb melanoma have an increased risk of death within 1 year after ILP when regional lymph node or distant metastases are present.