title: The Contemporary Role of Major Amputation in the Management of Advanced Limb Melanoma.
abstract: BACKGROUND
  Major amputations are rarely performed for melanoma, with limb-preserving techniques used whenever possible. This article reviews the indications for major amputation in patients with melanoma and reports outcomes with the aim of better classifying progressive and potentially curable disease patterns.
  
  
  METHODS
  At a single institution in Australia, 55 major amputations were performed for melanoma in 51 patients treated between 1984 and 2012. Clinicopathologic characteristics, treatments before amputation, and outcomes were analyzed.
  
  
  RESULTS
  The 55 cases included 17 upper limb (9 forequarter) and 38 lower limb (3 hindquarter) amputations. The most common reasons for amputation were progressive in-transit metastases (ITM, 67 %), troublesome limb metastases from distant sites (14 %), pain or ulceration after regional chemotherapy (14 %) and otherwise inoperable regional recurrence (6 %). Regional chemotherapy was used before amputation for 58 % of the patients, and for those with ITM, it was associated with an increased interval between ITM diagnosis and amputation. The overall 5-year survival rate (5YS) from the time of amputation was 22.8 %. For stage 3 patients with either ITM or regional recurrence, who had all known disease resected at the time of amputation, the 5YS was 38.4 %.
  
  
  CONCLUSIONS
  Major amputation may be indicated for advanced limb melanoma when limb-preserving strategies have been exhausted. Although they have advanced locoregional disease, some patients undergoing potentially curative amputation can achieve long-term survival.
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Read
authors.affiliation: Bone and Soft Tissue Sarcoma Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Stalley
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia. john.thompson@melanoma.org.au.|Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. john.thompson@melanoma.org.au.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. john.thompson@melanoma.org.au.
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008545:Melanoma / Q000150:complications / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology / Q000601:surgery; D012878:Skin Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D034941:Upper Extremity
chemical_list: D000970:Antineoplastic Agents