Hyperthermic regional perfusion in high-risk stage-I malignant melanomas of the extremities.

Local recurrence after conventional surgical treatment of malignant melanomas of the extremities has frequently been observed in our department in the past. As at other centers, this sometimes necessitated amputation, and on a few occasions amputations were performed exclusively for palliative reasons. In an effort to improve this situation, regional perfusion as local regional treatment was added to conventional therapy in 1965. We have since observed no further instances of massive local tumor growth, and since that time no amputations have had to be performed for this reason. Of course this complicated therapy caused new problems, particularly in the early years, but we have learned to reduce these to what we believe to be an acceptable minimum. In the last 2 years we have done nearly 100 perfusions and have had no major complications. A comparison of the results of regional perfusion plus local excision in the treatment of stage-I melanoma with those of other reported series (Cascinelli et al. 1978; Elder et al. 1979; Fortner et al. 1977; Goldsmith et al. 1970; Lee 1979; McCarthy et al. 1974; Veronesi et al. 1977; Wanebo et al. 1975) treated only by local excision is difficult, owing to the complexity of the known variables relating to survival and local recurrence. The 5-16 year determinate survival rate for our perfusion patients was 74%. The local recurrence rate in the perfused extremities was 9%, 14 patients, and nine of these 14 had distant metastases as well. The other five patients still show no evidence of disease after retreatment.(ABSTRACT TRUNCATED AT 250 WORDS)