Kirkwood J M, Ariyan S, Nordlund J J, Forget B M
Cancer. 1982 Oct 1;50(7):1299-303. doi: 10.1002/1097-0142(19821001)50:7<1299::aid-cncr2820500714>3.0.co;2-#.
Patients with thick primary melanomas, (Stage I) or regional nodal spread (Stage II) are at substantial risk for recurrence following usual definitive surgical excision of the primary tumor with or without lymphadenectomy. Trials of nonspecific adjuvant agents such as bacille Calmette Guerin (BCG) in experimental animals and man suggest that antitumor effects are greatest when the agent is injected near tumor of limited mass. We report a new approach to adjuvant therapy using preoperative intralymphatic injections and intraoperative local instillations of the nonviable methanol extraction residue of bacille Calmette Guerin (MER). Thirteen individuals with thick primaries, regional metastases, or recurrent melanoma of the extremities have entered the experimental program. We report here one complication of this immunotherapy observed in four of 13 treated individuals, granulomatous lymphangitis. The clinical presentation, course, and treatment of this complication are described. Its potential relation to the success of this therapy is discussed.
原发性厚黑色素瘤（I期）或区域淋巴结转移（II期）患者，在对原发性肿瘤进行常规确定性手术切除（伴或不伴淋巴结清扫术）后，复发风险很高。在实验动物和人体中对诸如卡介苗（BCG）等非特异性辅助剂进行的试验表明，当在肿块有限的肿瘤附近注射该制剂时，抗肿瘤效果最佳。我们报告了一种辅助治疗的新方法，即术前进行淋巴管内注射以及术中对卡介苗（BCG）的无活性甲醇提取残渣（MER）进行局部滴注。13例患有原发性厚黑色素瘤、区域转移或四肢复发性黑色素瘤的患者已进入该实验项目。我们在此报告在13例接受治疗的患者中有4例观察到的这种免疫疗法的一种并发症，即肉芽肿性淋巴管炎。描述了该并发症的临床表现、病程及治疗方法。讨论了其与该疗法成功与否的潜在关系。
