Biologic behavior and treatment of intransit metastasis of melanoma.

The therapeutic approach to intransit metastasis of melanoma has been surveyed in 52 patients admitted to this institute during the past ten years with a clinical history of intransit lesions of melanoma. Ten of these patients have been long term survivors. Two additional patients died at 23 and 28 months, respectively, after surgical removal of the lesions, and at autopsy, no evidence of recurrence was noted. All long term survivors belong to the group of 35 patients that received intensive local management, while all 17 patients given systemic chemotherapy or immunotherapy only died from progression of the disease. Every trial of system chemotherapy or system immunotherapy, aiming to control these lesions of intransit metastasis, failed. Systemic chemotherapy or systemic immunotherapy should not be used alone in the treatment of intransit metastasis. Such regional modalities as hyperthermic perfusion, local immunotherapy or excisions of wide strips of skin, subcutaneous fat and fascia around these lesions, in addition to systemic treatment, should be utilized persistently.