Hyperthermic Regional Perfusion for Melanoma of the Limbs

Regional chemotherapy delivered using isolated limb perfusion for advanced extremity melanoma was developed in the late 1950s as a way to manage in-transit disease in an era when there were few systemic options for patients with metastatic melanoma. Over the years, the technique evolved to include hyperthermia and biologic compounds like tumor necrosis factor and became the main treatment for patients with intransit melanoma. Since 2000, there has been a steady decline in the frequency of limb perfusion procedures. Initially thiswas related to the development of a less invasive technique to deliver regional chemotherapy called isolated limb infusion. More recently since 2010, the development of effective systemic treatments for melanoma, as well as novel intralesional therapies, has markedly altered the need for regional perfusion therapy such that it is uncommonly used. This chapter highlights the development and evolution of isolated limb perfusion therapy and what has changed in the last few years to replace it in managing patients with in-transit disease. This chapter should be cross-referenced with the chapters on isolated limb infusion, in-transit disease, and intralesional injections for the management of in-transit disease.