Regional isolated perfusion with melphalan for patients with subungual melanoma.
From 1978 to 1990, 24 patients with subungual melanoma (MD Anderson Stage I, 17, Stage III, 7 patients) were treated with amputation of a digit and regional isolated perfusion with melphalan. The lesions were located on the big toe in 14 (58%) patients. Median delay in definitive treatment was 21 months, while 14 patients (58%) had been subjected to some form of inadequate treatment before correct diagnosis was made. Median follow-up for the living patients was 48 months. Overall 5-year survival was 54% (Stage I, 68%, Stage III, 19% (log-rank P = 0.003)). Sex and site of the lesion did not influence survival. Compared to literature data of patients treated by amputation alone, no improvement in survival could be demonstrated despite perfusion treatment. Moreover, two limb and 7 regional node recurrences were seen. The benefit of adjuvant perfusion in the treatment of Stage I subungual melanoma has not been demonstrated in this study. The results of prospective randomized trials in primary high-risk extremity melanoma have to be awaited.
Vrouenraets
B C
BC
Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Amsterdam.
Kroon
B B
BB
Klaase
J M
JM
van Geel
B N
BN
Eggermont
A M
AM
Mooi
W J
WJ
van Dongen
J A
JA
D000368:Aged; D000671:Amputation, Surgical; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D005385:Fingers; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009260:Nail Diseases / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D015996:Survival Rate; D014034:Toes
D008558:Melphalan