Long-term functional morbidity after mild hyperthermic isolated limb perfusion with melphalan

Aims: To assess long-term functional morbidity in patients entered in the p rospective randomized EORTC trial investigating the role of adjuvant isolat ed limb perfusion (ILP) with melphalan for high-risk primary melanoma. Methods: In 65 patients (ILP 36, wide excision only 29), limb circumference and joint mobility measurements were performed on the treated and the cont ralateral limb after a mean interval of 48 months after primary treatment. The two treatment groups were comparable regarding age, sex distribution, p ercentage of skin grafts or regional lymphnode dissections, and interval be tween primary treatment and physical measurements. Results: None of the patients had severe complaints of the treated limb at the time of analysis. The ankle suffered most from ILP, with a statistical significant restricted extension in approximately 40% of the perfused patie nts. Abduction of the shoulder was minimally affected in treated upper limb s, probably as a result from the formation of scar tissue after axillary ly mph-node dissection. Although no significant differences could be demonstra ted in the circumference of upper or lower limbs, atrophy was seen in 24% o f perfused lower limbs. Of the five perfused patients who developed oedema, four had also undergone a regional lymph-node dissection. Conclusion: This risk of long-term functional morbidity should be weighed a gainst the possible advantages of ILP in patients with limb melanoma or sar coma.