EDITORIAL COMMENT Defining the Role of Isolated Therapy for Extremity Melanoma Hiram C. Polk, Jr., Louisville, Kentucky have pointed out, the effect was on occasion more short- lived than one might have hoped and ultimately was as- sociated with further progression of the disease in the majority of those studied, sometimes resulting in death. Failure to achieve prolonged survival of more than 3 years in this group of patients may not be a fair test for the mo- dality itself; indeed, the authors’ conclusion that the method should be reserved for palliation is, in my opinion, not supported by current data. In this issue of the JozmzaZ, Storm and Morton [I] have examined the impact of hyperthermic regional limb perfusion, using the pump oxygenator for advanced regional recurrent malignant melanoma. The report is important for several reasons. First, the authors once again testify to the widely noted therapeutic effect of regional perfusion for malignant melanoma. They also correctly describe the very long local control of neoplastic disease, and further describe acceptable morbidity and, again, the absence of mortality. The application of hyperthermic extremity perfusion, very similar to that outlined by Storm and Morton, has sometimes seemed to increase survival rates in patients with clinical Stage I disease. A most impressive report to this end has just been published by Ghussen et al [2]. The precautions and physiologic observations noted during the course of the studies are essentially correct and should be appreciated by all who are trying to define the proper ap- plications and sequences of available therapies for patients with malignant melanoma. My own unpublished data support their observations very strongly. Only 3 of 75 upper and lower extremity perfusions undertaken for management of advanced local disease, regional disease, or both failed to show an objective response in the visible disease. Just as Storm and Morton References 1. Storm FK, Morton DL. Value of therapeutic hyperthermic limb perfusion in advanced recurrent melanoma of the lower extremity. Am J Surg 1985;150:32-5. From the Depdnml of Sugary. Univedy of Louisville school of fkdcine. Louisville, Kentucky. 2. Ghussen-F, Nagel K, &oth W, Milier JM, StUtzer H. A prospective 6tuly of regional extremity perfusion in patients with rnslignsnt melanoma. Ann Surg 1984;200:784-8. 176 The American Journal cf Scrgery

Defining the role of isolated therapy for extremity melanoma

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EDITORIAL COMMENT

Defining the Role of Isolated Therapy for Extremity Melanoma

Hiram C. Polk, Jr., Louisville, Kentucky

have pointed out, the effect was on occasion more short- lived than one might have hoped and ultimately was as- sociated with further progression of the disease in the majority of those studied, sometimes resulting in death. Failure to achieve prolonged survival of more than 3 years in this group of patients may not be a fair test for the mo- dality itself; indeed, the authors’ conclusion that the method should be reserved for palliation is, in my opinion, not supported by current data.

In this issue of the JozmzaZ, Storm and Morton [I] have examined the impact of hyperthermic regional limb perfusion, using the pump oxygenator for advanced regional recurrent malignant melanoma. The report is important for several reasons. First, the authors once again testify to the widely noted therapeutic effect of regional perfusion for malignant melanoma. They also correctly describe the very long local control of neoplastic disease, and further describe acceptable morbidity and, again, the absence of mortality.

The application of hyperthermic extremity perfusion, very similar to that outlined by Storm and Morton, has sometimes seemed to increase survival rates in patients with clinical Stage I disease. A most impressive report to this end has just been published by Ghussen et al [2]. The precautions and physiologic observations noted during the course of the studies are essentially correct and should be appreciated by all who are trying to define the proper ap- plications and sequences of available therapies for patients with malignant melanoma.

My own unpublished data support their observations very strongly. Only 3 of 75 upper and lower extremity perfusions undertaken for management of advanced local disease, regional disease, or both failed to show an objective response in the visible disease. Just as Storm and Morton

References

1. Storm FK, Morton DL. Value of therapeutic hyperthermic limb perfusion in advanced recurrent melanoma of the lower extremity. Am J Surg 1985;150:32-5.

From the Depdnml of Sugary. Univedy of Louisville school of fkdcine. Louisville, Kentucky.

2. Ghussen-F, Nagel K, &oth W, Milier JM, StUtzer H. A prospective 6tuly of regional extremity perfusion in patients with rnslignsnt melanoma. Ann Surg 1984;200:784-8.

176 The American Journal cf Scrgery