The role of hyperthermic antiblastic perfusion in the treatment of high risk stage I limb melanoma (thickness > 1.5mm)

The most correct therapeutic stategy for treating stage I melanoma is still a controversial issue. Of the prognostic factors able to predict the outcome of the disease, the most reliable is the tumour thickness. A high correlation exists between the survival rate and this parameter. Wide excision (with or without node dissection) appears to control melanoma when the tumor thickness is > 1.5mm. Over this limit, the greater the tumor thickness, the lower the survival rate is. The present study is aimed at evaluatinf the advantages of limb perfusion for treating high risk stage 1 limb melanoma patients ( > 1.5mm thickness). We have treated 47 patients with hyperthermic antiblastic perfusion employing melphalan (10 mg/liter of the perfused limb) at a muscle temperature ranging between 41 and 41.5°c. The five and ten-year actuarial survival rates obtained are 87.8% and 80% respectively. Only one skin recurrence was observed and seven of the patients developed regional node metastases. The resultes obtained thus far seem to indicate that hyperthermic antiblastic perfusion provides better control of the disease than surgey both regarding the icidence of local recurrences as well as survival rates. However, the ongoing multicentric randomized study begun in 1984 must be concluded before definitive conclusions may be made.