Total abdominal perfusion (TAP) in the treatment of abdominal metastatic melanoma

Total abdominal perfusion (TAP) is a recently described technique in which the abdominal organs are isolated from the systemic circulation and perfused by means of an external pump. Administering chemotherapy into the circuit provides higher locoregional drug exposure with lower systemic toxicity. Two patients with melanoma metastatic to the abdomen were treated using this technique. The first patient suffered from intractable upper gastrointestinal bleeding due to unresectable melanoma metastasis of the duodenum. He underwent TAP with melphalan and cisplatinum. His bleeding stopped and the tumor regressed. The patient's response lasted for 6 months. The second patient had an unresectable liver metastasis. She underwent TAP with melphalan and DTIC, resulting in a complete response with disappearance of the liver mass, which lasted until her death in 13 months. Our conclusion is that TAP should be considered as a technique for regional chemotherapy, which may be used in the treatment of unresectable metastatic melanoma of the abdomen.