Isolated Limb Perfusion for Stage III Melanoma: Does It Still Have a Role in the Present Era of Effective Systemic Therapy?

The management of advanced-stage melanoma has changed dramatically with the introduction of systemic targeted therapy and immunotherapy. Patients with stage IV melanoma currently benefit from agents that are extremely effective, especially when compared with classic chemotherapeutic agents. The field is still evolving, and these newer agents are now used in patients with stage III disease, in the setting of adjuvant trials after resection of the disease bulk. Patients with bulky and numerous in-transit metastases form a very distinct subset of melanoma patients. The disease is classically staged as stage III, but because it is usually unresectable, a regional or systemic rather than a local approach is warranted. Isolated limb perfusion (ILP) is a regional technique that has been shown to provide high response rates and tumor control. The impressive results of ILP were obtained in the era of ineffective systemic agents. Now that this situation has profoundly changed, questions arise as to what the role of ILP is in the treatment of patients with melanoma in-transit metastases, which patients are ideal candidates for ILP, and whether ILP is here to stay-or will become obsolete in the near future.