Melanoma: the management of local recurrence and in-transit metastasis

Following the primary treatment of melanoma, subsequent appearance of local recurrence and in-transit metastasis remains one of the most difficult problems faced by surgeons. In managing the disease at this stage, it is important to realize that, because of a favourable immune reaction in some patients, the disease may remain localized for many months or years. Consequently, local control should be attempted in the best possible manner when the disease is confined to a specific region and there are no signs of dissemination. Methods of local control include local surgical procedures, local and systemic chemotherapy, immunotherapy, radiotherapy, amputation and isolation-perfusion. After reviewing the literature and based upon personal experience, the author found that hyperthermic isolation-perfusion can be effective in the management of local recurrences of melanomas and in-transit metastasis.