title: Pharmacotherapy of regional melanoma therapy.
abstract: BACKGROUND
  In-transit melanoma metastases develop within regional dermal and subdermal lymphatics before reaching the regional lymph nodes. The prognosis is poor and comparable to multiple nodal metastases. Isolated limb infusion (ILI) or perfusion (ILP) are effective treatments for unresectable, in-transit melanoma, with response rates reaching 95%. Although ILI and ILP are more effective than systemic therapy, most patients will recur, thus highlighting the need for newer strategies to improve durable response rates.
  
  
  METHODS
  We review historical and current literature from 1958 to 2009 regarding regional therapy for melanoma, with focus on the ILI and ILP techniques, pharmacokinetics and resistance mechanisms of melphalan. Alternative therapies, adjunct strategies and new targeted therapies aimed at improving response rates and long-term remission are also discussed.
  
  
  RESULTS
  The reader will gain a comprehensive review on regional pharmacotherapy for melanoma, including alternative therapies, adjunct strategies and new targeted therapies.
  
  
  CONCLUSIONS
  Regional chemotherapy is a viable, evolving treatment for patients with in-transit melanoma and a springboard for ongoing research aimed at improving therapies for malignant melanoma.
authors.affiliation: Duke University Medical Center, Department of General Surgery, DUMC Box 3443, Durham, NC 27710, USA.
authors.forename: James
authors.initials: J
authors.lastname: Padsis
authors.forename: Ryan
authors.initials: R
authors.lastname: Turley
authors.forename: Douglas
authors.initials: D
authors.lastname: Tyler
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005121:Extremities / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007261:Infusions, Intra-Arterial; D008207:Lymphatic Metastasis / Q000473:pathology*; D008545:Melanoma / Q000473:pathology* / Q000628:therapy; D008558:Melphalan / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local; D012878:Skin Neoplasms / Q000188:drug therapy; D012983:Soft Tissue Neoplasms / Q000473:pathology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan