Some aspects of the treatment of primary malignant melanoma of the extremities by isolated regional perfusion

This paper reviews the changing concepts in the treatment of patients with malignant melanoma localized on the arm or leg. In addition to conventional surgical treatment, isolated regional perfusion of the extremities is discussed. An evaluation is presented of clinical and histological criteria applied to determine indications for conventional surgical treatment and for perfusion. It is maintained that isolated regional perfusion of arm or leg should be performed when the primary tumor meets one of the following criteria: (1) depth of tumor invasion beyond the papillary layer (Clark levels III, IV and V); (2) vascular invasion; (3) tumor diameter exceeding 1 cm; (4) ulceration. If none of these four criteria applies, conventional surgical treatment alone has proved to give very good results.