title: Management of in-transit metastases from cutaneous malignant melanoma.
abstract: BACKGROUND
  In-transit metastases from cutaneous malignant melanoma (cutaneous or subcutaneous deposits between the primary melanoma and regional lymph nodes) represent late-stage disease, and their treatment should be tailored accordingly. This article reviews the pathology, clinical significance and treatment options for in-transit disease from melanoma.
  
  
  METHODS
  An initial Medline search was undertaken using the keywords 'melanoma and in-transit' and 'melanoma and non-nodal regional recurrence'. Additional original articles were obtained from citations in articles identified by the initial search.
  
  
  CONCLUSIONS
  In-transit metastases carry a poor prognosis. The method of treatment should be tailored to the extent of cutaneous disease. The first line of treatment remains complete excision with negative histopathological margins. There is no need for wide excision. Carbon dioxide laser therapy is valuable for multiple small cutaneous deposits. Isolated limb perfusion has a role for numerous or bulky advanced in-transit metastases in the limbs that are beyond the scope of simpler techniques. Systemic chemotherapy has response rates of about 25 per cent and is reserved for patients for whom surgery is no longer feasible.
authors.affiliation: Sarcoma and Melanoma Unit, Department of Surgery, Royal Marsden Hospital, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hayes
authors.forename: M A
authors.initials: MA
authors.lastname: Clark
authors.forename: M
authors.initials: M
authors.lastname: Harries
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
mesh_terms: D000671:Amputation, Surgical; D010478:Chemotherapy, Cancer, Regional Perfusion; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D009626:Terminology as Topic