Giant melanoma of the left thumb

A 74-year-old female patient is described with a giant melanoma of the left thenar and concomitant bilateral pulmonary metastases. Palliative treatment consisted of a two-staged procedure in order to save the limb from amputation. Firstly, perfusion with gamma-interferon, tumour necrosis factor- alpha and melphalan was carried out, after which the tumour had been reduced to one third of its initial volume. Secondly, excision of the tumour and coverage of the wound with a split skin graft was done. Remarkably, the extent of the multiple pulmonary metastases was temporary and diminished 1 month after perfusion, although no systemic leakage could be determined during the procedure. The management strategy is discussed with emphasis on this indication for limb perfusion.