Hyperthermic perfusion of recurrent malignant melanoma on the extremities

Twenty-one patients with recurrent malignant melanoma on the extremities were treated by regional hyperthermic perfusion with melphalan (Alkeran). Four patients had a second perfusion. The recurrence site was on the foot in one patient, on the lower part of the leg in 13 patients, below the mid-thigh in 6 patients and on the elbow in one patient. The temperature of the extremities was registered continuously during the perfusion. Perfusion was performed under hyperthermic conditions with a temperature of 40-41.0 degrees C i.m. The perfusion time was 2 hours. Alkeran was given in a dose of 0.9 mg/kg bodyweight for lower extremity perfusion and 0.45 mg/kg for upper extremity perfusion. Complete tumour regression or more than 50% tumour regression was registered in 8 out of the 10 patients with manifest tumour. As the first sign of recurrence after perfusion, 4 patients had local recurrence and 10 had systemic recurrence. Altogether one-third of the patients had local recurrences and half of the patients systemic recurrences. Local recurrences occurred after a median time of 8 months and systemic recurrences after a median time of 7 months. Nine patients are still alive after an observation time of 5.5 months to 44 months. Three patients are without any signs of recurrent disease.