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. 1982 Sep;196(3):316–323. doi: 10.1097/00000658-198209000-00010

The treatment of state I melanoma of the extremities with regional hyperthermic isolation perfusion.

K A Janoff, D Moseson, J Nohlgren, C Davenport, C Richards, W S Fletcher
PMCID: PMC1352606  PMID: 7114937

Abstract

One hundred twenty-two clinically Stage I malignant melanoma patients were treated prospectively in a nonrandomized trial by hyperthermic isolation perfusion with l-phenylalanine mustard (l-Pam), regional lymphadenectomy (RL), and wide local excision (WLE) between April 1965 and July 1980. There were 31 males and 91 females. All primary lesions were retrospectively microstaged by Clark's levels and Breslow's thickness criteria by one of the senior authors. Morphologically, 71% were superficial spreading melanomas (SSM), 16.5% were nodular melanomas (NM), and 11.9% were acral lentiginous melanomas. Survival by microstaging and morphology are reported in Table 1. Eighty-one per cent of all patients were disease-free at five years. Twenty-three patients (18.8%) recurred and of these, 15 died of their disease. This included six of the seven patients with histologically positive lymph nodes. Complications were not only acceptable but preventable and will be discussed. Microstaging provides a valid basis by which to compare treatment regimens and, more importantly, a valid criteria by which to select treatment for a given patient. These data compare favorably with other reported series. At the time these studies were initiated, five-year survivals for clinically Stage I and II melanoma were roughly 55% and 15%, respectively. Existing data clearly indicate that hyperthermic isolation perfusion with RL is superior to WLE and warrants further study in selected patients.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balch C. M., Murad T. M., Soong S. J., Ingalls A. L., Halpern N. B., Maddox W. A. A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods. Ann Surg. 1978 Dec;188(6):732–742. doi: 10.1097/00000658-197812000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. 1970 Nov;172(5):902–908. doi: 10.1097/00000658-197011000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Breslow A. Tumor thickness, level of invasion and node dissection in stage I cutaneous melanoma. Ann Surg. 1975 Nov;182(5):572–575. doi: 10.1097/00000658-197511000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CREECH O., Jr, KREMENTZ E. T., RYAN R. F., WINBLAD J. N. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958 Oct;148(4):616–632. doi: 10.1097/00000658-195810000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cavaliere R., Ciocatto E. C., Giovanella B. C., Heidelberger C., Johnson R. O., Margottini M., Mondovi B., Moricca G., Rossi-Fanelli A. Selective heat sensitivity of cancer cells. Biochemical and clinical studies. Cancer. 1967 Sep;20(9):1351–1381. doi: 10.1002/1097-0142(196709)20:9<1351::aid-cncr2820200902>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  6. Clark W. H., Jr, From L., Bernardino E. A., Mihm M. C. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. 1969 Mar;29(3):705–727. [PubMed] [Google Scholar]
  7. FORTNER J. G., BOOHER R. J., PACK G. T. RESULTS OF GROIN DISSECTION FOR MALIGNANT MELANOMA IN 220 PATIENTS. Surgery. 1964 Apr;55:485–494. [PubMed] [Google Scholar]
  8. Gupta T. K. Results of treatment of 269 patients with primary cutaneous melanoma: a five-year prospective study. Ann Surg. 1977 Aug;186(2):201–209. doi: 10.1097/00000658-197708000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hahn G. M. Potential for therapy of drugs and hyperthermia. Cancer Res. 1979 Jun;39(6 Pt 2):2264–2268. [PubMed] [Google Scholar]
  10. Hersh E. M., McBride C. M., Gschwind C. Local and systemic immunologic effects of perfusion therapy for malignant melanoma. Surg Gynecol Obstet. 1973 Sep;137(3):461–464. [PubMed] [Google Scholar]
  11. KREMENTZ E. T., KNUDSON L. The effect of increased oxygen tension on the tumoricidal effect of nitrogen mustard. Surgery. 1961 Jul;50:266–273. [PubMed] [Google Scholar]
  12. Krementz E. T., Ryan R. F. Chemotherapy of melanoma of the extremities by perfusion: fourteen years clinical experience. Ann Surg. 1972 Jun;175(6):900–917. doi: 10.1097/00000658-197206010-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. LEATHER R. P., ECKERT C. Hyperbaric oxygenation and mechlorethamine effectiveness. Arch Surg. 1963 Jul;87:144–147. doi: 10.1001/archsurg.1963.01310130146018. [DOI] [PubMed] [Google Scholar]
  14. Marmor J. B. Interactions of hyperthermia and chemotherapy in animals. Cancer Res. 1979 Jun;39(6 Pt 2):2269–2276. [PubMed] [Google Scholar]
  15. McBride C. M., Smith J. L., Jr, Brown B. W. Primary malignant melanoma of the limbs: a re-evaluation using microstaging techniques. Cancer. 1981 Sep 15;48(6):1463–1468. doi: 10.1002/1097-0142(19810915)48:6<1463::aid-cncr2820480631>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  16. McBride C. M., Sugarbaker E. V., Hickey R. C. Prophylactic isolation-perfusion as the primary therapy for invasive malignant melanoma of the limbs. Ann Surg. 1975 Sep;182(3):316–324. doi: 10.1097/00000658-197509000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McCarthy J. G., Haagensen C. D., Herter F. P. The role of groin dissection in the management of melanoma of the lower extremity. Ann Surg. 1974 Feb;179(2):156–159. doi: 10.1097/00000658-197402000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. McGovern V. J. The classification of melanoma and its relationship with prognosis. Pathology. 1970 Apr;2(2):85–98. doi: 10.3109/00313027009077330. [DOI] [PubMed] [Google Scholar]
  19. Moore G. E., Gerner R. E. Malignant melanoma. Surg Gynecol Obstet. 1971 Mar;132(3):427–436. [PubMed] [Google Scholar]
  20. STEHLIN J. S., Jr, CLARK R. L. MELANOMA OF THE EXTREMITIES. Am J Surg. 1965 Sep;110:365–365. doi: 10.1016/0002-9610(65)90075-9. [DOI] [PubMed] [Google Scholar]
  21. Schraffordt Koops H., Oldhoff J., van der Ploeg E., Vermey A., Eibergen R., Beekhuis H. Some aspects of the treatment of primary malignant melanoma of the extremities by isolated regional perfusion. Cancer. 1977 Jan;39(1):27–33. doi: 10.1002/1097-0142(197701)39:1<27::aid-cncr2820390106>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  22. Sim F. H., Taylor W. F., Ivins J. C., Pritchard D. J., Soule E. H. A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Preliminary results. Cancer. 1978 Mar;41(3):948–956. doi: 10.1002/1097-0142(197803)41:3<948::aid-cncr2820410324>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  23. Southwick H. W. Malignant melanoma. Role of node dissection reappraised. Cancer. 1976 Jan;37(1):202–205. doi: 10.1002/1097-0142(197601)37:1<202::aid-cncr2820370129>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  24. Stehlin J. S., Jr, Giovanella B. C., de Ipolyi P. D., Anderson R. F. Results of eleven years' experience with heated perfusion for melanoma of the extremities. Cancer Res. 1979 Jun;39(6 Pt 2):2255–2257. [PubMed] [Google Scholar]
  25. Stehlin J. S., Jr Hyperthermic perfusion with chemotherapy for cancers of the extremities. Surg Gynecol Obstet. 1969 Aug;129(2):305–308. [PubMed] [Google Scholar]
  26. Sugarbaker E. V., McBride C. M. Survival and regional disease control after isolation-perfusion for invasive stage I melanoma of the extremities. Cancer. 1976 Jan;37(1):188–198. doi: 10.1002/1097-0142(197601)37:1<188::aid-cncr2820370127>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  27. Veronesi U., Adamus J., Bandiera D. C., Brennhovd I. O., Caceres E., Cascinelli N., Claudio F., Ikonopisov R. L., Javorskj V. V., Kirov S. Inefficacy of immediate node dissection in stage 1 melanoma of the limbs. N Engl J Med. 1977 Sep 22;297(12):627–630. doi: 10.1056/NEJM197709222971202. [DOI] [PubMed] [Google Scholar]
  28. Wagner D. E. A retrospective study of regional perfusion for melanoma. Arch Surg. 1976 Apr;111(4):410–413. doi: 10.1001/archsurg.1976.01360220106017. [DOI] [PubMed] [Google Scholar]
  29. Wanebo H. J., Fortner J. G., Woodruff J., MacLean B., Binkowski E. Selection of the optimum surgical treatment of stage I melanoma by depth of microinvasion: Use of the combined microstage technique (Clark-Breslow). Ann Surg. 1975 Sep;182(3):302–315. doi: 10.1097/00000658-197509000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wanebo H. J., Woodruff J., Fortner J. G. Malignant melanoma of the extremities: a clinicopathologic study using levels of invasion (microstage). Cancer. 1975 Mar;35(3):666–676. doi: 10.1002/1097-0142(197503)35:3<666::aid-cncr2820350320>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]

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