Regional Therapeutic Strategies in Melanoma: Not Just Local Disease Control, but an Opportunity to Develop Novel Therapeutic Strategies with Potential Implications for Systemic Therapy

Excerpt

Since the initial description of isolated regional chemotherapeutic perfusion therapy in 1958 by Creech et al.,1 there have been surprisingly few modifications to this therapeutic intervention for advanced extremity melanoma over the last 50 years. In this issue of Annals of Surgical Oncology, Kroon et al.2 publish their manuscript entitled “Outcomes following isolated limb infusion for melanoma. A 14-year experience,” which summarizes the Sydney Melanoma Unit’s experience using melphalan and dactinomycin for regionally advanced melanoma administered through a minimally invasive regional chemotherapy procedure that they developed and initially described. The initial results and subsequent follow-up suggest that isolated limb infusion (ILI) may be a reasonable alternative to hyperthermic isolated limb perfusion (HILP) in the management of regionally advanced melanoma, in the form of in-transit disease or local recurrence. However, as with any technique that is initially described in a large single-institutional fashion, care must be taken in defining the place for this treatment modality until its efficacy is tested on a wider scale. …