ISOLATED LIMB PERFUSION IN TREATMENT OF LOCALLY ADVANCED MELANOMA: STILL A THERAPEUTIC OPTION IN 2019 IN BRAZIL - CASE REPORT

Case Presentation: A 61-year-old male patient with melanoma, stage IIIb on the left foot, was diagnosed in 2010. He underwent margin excision and left inguinal emptying in the same year. After three years of follow-up, he had a locoregional recurrence. He underwent radiotherapy, two chemotherapy regimens with partial response and new local relapse, with no evidence of distant disease. In June 2019, the patient was referred to Oncologic Surgery for isolated limb perfusion (ILP) due to lack of access to systemic treatment based on target drug or immunotherapy. In the perioperative period, after isolating the limb in the extracorporeal circuit, the patient maintained systemic escape, making chemotherapy unfeasible. The venous leak was identified through the small saphenous vein with radiolabel escape for systemic circulation. The surgical team chose for double venous return cannulation with femoral vein and saphenous vein in the circuit. Perfusion of the limb with Melphalan heated at 41.5 degrees for 60 minutes. The patient had a good evolution, being discharged on the third postoperative day (POD). He returned at 14th POD with necrosis and apparent complete remission of limb disease. Discussion: A challenge for physicians and patients is advanced locoregional melanoma, which often does not respond to conventional chemotherapy treatment and has high relapse rates. In the case presented, we detail the approach of a patient with advanced left lower limb locoregional disease by the IMP method. This procedure consists of the use of high-dose chemotherapy on the affected limb, avoiding systemic circulation and its harmful effects. However, as described here, the surgeon may face unexpected situations during the perioperative period, especially vascular changes that require adaptability. Conclusion: Treatment of locally advanced melanoma is complex and challenging. Besides the use of immunotherapy and target therapy in the adjuvant and palliative scenario, Isolated Limb Perfusion remains a therapeutic option for selected cases, presenting satisfactory results when performed by experienced and qualified surgical team to manage intraoperative complications

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019