[Extremity perfusion in malignant melanoma]

Isolation perfusion was introduced in 1957 by Creech and Krementz for treatment of in-transit metastases from malignant melanoma of the limbs. The isolation of the extremity from the body circulation allows a high concentration of cytostatics without systemic side effects. In combination with hyperthermic tissue temperatures around 41.5 degrees C an additional effect can be expected. Regional metastasizing malignant melanomas with satellites, in-transit or lymph node metastases are generally accepted indications for isolation perfusion. There is still controversy about elective adjuvant perfusion in stage I melanoma. In spite of performing this treatment modality over 40 years in practice there are still many factors under discussion and many problems to be solved. The surgical procedure and techniqual aspects are described in detail. Krementz demonstrated long term survival rates between 19% and 53%. The patients treated in the Surgical Department of the University Hospital in Erlangen since 1975 with satellites and in-transit metastases had a 10-year survival rate of 48%. Considering the historical data of our patients without perfusion with a 10-year survival of 11% there is a highly significant statistical difference. In conclusion isolation perfusion is the therapy of choice in patients with locally metastasized malignant melanoma of the limbs.