MULTIPLE PERFUSIONS FOR MELANOMA

From 1957 to 1992,1139 patients had regional perfusion alone, or combi ned with excisional surgery for malignant melanoma. Of these, 158 pati ents had multiple perfusions for recurrent disease, including 155 for limb melanoma and three for head and neck melanoma. One-hundred-and-tw enty patients were perfused twice, 28 treated three times, eight treat ed four times, and two treated five times. At first perfusion, 39 pati ents were classified as diasease stages I and II, 98 at stage III, and 21 at stage IV. Melphalan was used in 70% of perfusions, either alone or in combination. Nitrogen mustard was used sparingly in only a few patients. Fifty-one patients with stage III disease had the greatest n umber of perfusions (127). Cumulative survival f rom date of first per fusion at 5 and 10 years were: stage I, 68 and 36%; stage IIIA, 25 and 16%; stage IIIB, 32 and 10%; stage IIIAB, 29 and 11% and stage IV, 14 and 0%. When compared with the entire series, the percent survival wa s decreased by 2 to 3 times, however, 21 patients remain alive and dis ease-free. For stages I and II, patients are alive and disease-free fr om 5 to 33 years. For stage IIIA, 6 patients were alive at the last fo llow-up, however, the status of two are currently unknown. For stage I IIB survival times range from 8 to 106 months with two patients alive without recurrence. For stage IIIAB, two patients are alive and diseas e-free at 15 and 26 years. For stage IV, two patients are alive at 7 a nd 26 years following perfusion and resection of recurrent melanoma in iliac nodes. In this series there were one post-operative and two che motherapy deaths from myocardial infarction. This study underlines the theory that multiple perfusions for recurrent melanoma are of value i n controlling less aggressive, regionally confined malignant melanoma.