Prophylactic hyperthermic limb perfusion in stage I melanoma

Area of Science:

• Oncology
• Dermatology
• Surgical Oncology

Background:

• Cutaneous malignant melanoma of the lower limb presents unique treatment challenges.
• Wide local excision is a standard treatment, but regional control remains critical.
• Adjuvant therapies are explored to improve outcomes for melanoma patients.

Purpose of the Study:

• To evaluate the efficacy of hyperthermic isolated regional perfusion (HIRP) with melphalan as an adjuvant therapy for stage I primary cutaneous malignant melanoma of the lower limb.
• To assess the impact of HIRP on melanoma recurrence, survival rates, and local/regional control.
• To identify prognostic factors influencing melanoma recurrence and survival in this patient cohort.

Main Methods:

• A prospective non-randomized study involving 93 patients with stage I lower limb melanoma.
• Treatment consisted of wide local excision combined with HIRP using melphalan (L-phenylalanine dihydrochloride).
• Data on recurrence, metastasis, survival, and morbidity were collected and analyzed.

Main Results:

• Eighteen patients (19.4%) experienced melanoma recurrence, with nine having regional disease (including in-transit metastases and positive regional nodes).
• No local recurrence was observed. Seventy-nine percent of patients were disease-free at 5 years, with an overall 5-year survival of 83%.
• Males presented with deeper lesions and higher recurrence rates (33%) compared to females (13%). Superficial spreading melanoma showed the most favorable prognosis.

Conclusions:

• Hyperthermic isolated regional perfusion with melphalan is an effective adjuvant therapy for improving local and in-transit control of limb melanoma.
• Tumor microstaging, patient sex, and histological type are significant prognostic factors for melanoma recurrence and survival.
• While effective, significant morbidity such as deep vein thrombosis can occur, necessitating careful patient selection and monitoring.