Local recurrence and survival in patients with (Clark Level IV/V and over 1.5-mm thickness) stage I malignant melanoma of the extremities after regional perfusion.

During the period 1965-1974, 110 patients with stage I malignant melanoma of the extremities were treated by regional isolated perfusion with L-phenylalanine mustard and local excision. In order to study local recurrence and survival, only patients with a primary melanoma Clark Level IV or V and a tumor thickness of more than 1.5 mm were accepted in this study. The determinate survival in patients followed for 5-14 years in 78%; 17% developed positive regional lymph nodes. The local skin recurrence rate was 9% (9 patients); four of these 9 patients simultaneously had distant metastases; the other five patients are alive with NED after retreatment. This series of patients, too, shows that tumor thickness determines the prognosis, both as to local recurrence and as to survival. The mean tumor thickness in the hyperthermically perfused patients was found to clearly exceed that in the normothermically perfused, the mean values being 4.85 mm and 3.87 mm, respectively. Yet local recurrence and regional lymph node metastases proved to be less frequent after hyperthermic than after normothermic perfusion, although the difference was not statistically significant.