title: Therapy for unresectable recurrent and in-transit extremity melanoma.
abstract: BACKGROUND
  Unresectable recurrent and in-transit extremity melanoma presents a dilemma for the treating physician. While the disease is confined to the involved limb, the survival mimics that of multiple nodal metastases, with a 10-year survival rate of approximately 40%. This represents late-stage disease for which curative treatment options are limited.
  
  
  METHODS
  To review the current treatment strategies for stage IIIB (N2c) in-transit and recurrent melanoma focusing on the options for unresectable disease, MEDLINE was searched for studies of known and experimental treatments for in-transit and recurrent extremity melanoma. Further results were obtained after review of the initial citations.
  
  
  RESULTS
  For unresectable recurrences and in-transit metastases, therapies are limited to palliative (radiation), local (intratumoral injection, laser ablation and electroporation), regional (isolated limb perfusion/infusion), and systemic (chemotherapy) when local or regional techniques are not feasible.
  
  
  CONCLUSIONS
  In this patient population, intratumoral techniques have a limited role with current treatment regimens, but with the development of new drugs, these techniques may have more utility. If not contraindicated, regional techniques provide the greatest control and have minimal operative morbidity. Until new regimens are available, systemic therapy continues to be associated with considerable toxicity and only marginal response rates.
authors.affiliation: Cutaneous Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Gimbel
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018274:Electroporation / Q000379:methods*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007866:Leg; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents