Al. Feldman et al., Management of extremity recurrences after complete responses to isolated limb perfusion in patients with melanoma, ANN SURG O, 6(6), 1999, pp. 562-567
Background: Despite high rates of complete responses (CRs) to isolated limb
perfusion (ILP) for patients with in-transit melanoma (60% to 90%), extrem
ity recurrences are common. We evaluated our experience with managing these
recurrences to determine how best to treat these patients.
Methods: Between April 1992 and April 1998, 72 patients experienced CRs aft
er hyperthermic ILP using Melphalan, with (n = 46) or without (n = 26) tumo
r necrosis factor. Of these, 25 patients (35%) experienced initial recurren
ces in the extremities, and they form the basis of this study.
Results: Three patients who underwent repeat ILP for treatment of their rec
urrences experienced a second CR and recurrence in the extremity (at 9, 15,
and 16 months), allowing analysis of 28 cases. For 5 of 20 recurrences man
aged with excision, 2 of 6 managed with repeat lip, and 0 of 2 managed with
systemic treatment, the patient was free of disease at the last follow-up
examination (median follow-up period, 11 months).
Conclusions: Isolated extremity recurrences after CRs to ILP occurred in 35
% of patients. Initially, these could be managed successfully by excision o
r repeat lip for the majority of patients (92%). We recommend excision of s
mall-volume recurrent disease, reserving repeat lip for patients with incre
asing numbers of lesions or increasing rapidity of in-field recurrences.