Second malignant neoplasm occurring years after hyperthermic isolated limb perfusion for melanoma

Hyperthermic isolated limb perfusion (HILP) is a useful therapeutic option in patients with locally advanced melanoma of the extremities. Because HILP allows very high doses of cytotoxic agents to be administered without systemic leakage, the theoretical risk of a secondary malignant neoplasm is real, particularly in the treated limb. Such an event has never been reported to our knowledge, however, possibly in part because survival in these patients is often too short to permit the development of chemo-induced cancers.

We describe 2 cases of secondary rare cancers in 2 elderly women: 1 fatal pleomorphic sarcoma and 1 Merkel cell carcinoma, which developed on the same limb 16 years after HILP for melanoma. The first patient had an exceptional prolonged complete response after HILP for unresectable regional metastases, while the second had been overtreated with HILP and dacarbazine in an adjuvant setting for an early-stage melanoma.

Because long-term survivors of regionally advanced melanoma, although rare, do exist, candidates for HILP should be warned of the risk of long-term development of nonmelanoma secondary cancers. The risk-benefit balance of high-dose local chemotherapy should be carefully evaluated in the light of these findings, especially in patients with early-stage melanoma or other non-life-threatening medical conditions.