Isolated regional perfusion in the treatment of subungual melanoma
P. C. Baas, H. J. Hoekstra, H. Schraffordt Koops, J. W. Oosterhuis and J. Oldhoff
Division of Surgical Oncology, University Hospital, Groningen, The Netherlands.
Subungual melanoma is rare and represents only 1% to 3% of all diagnosed
melanomas in Western countries. The tumor is frequently mistaken for a
benign lesion and the delay in diagnosis and final treatment may be
responsible for the high local recurrence rate and the low disease-free
survival rate. From 1965 to 1982 the combined-modality therapy of
amputation and adjuvant isolated regional perfusion with melphalan with or
without dactinomycin was used in the treatment of 22 patients with
subungual melanoma. Disease was staged according to the M. D. Anderson
classification, as follows: stage I (primary melanoma), 11 patients; stage
IIIA (in-transit metastases and/or satellitosis), three patients; stage
IIIB (regional lymph nodes), seven patients; and stage IIIAB (in-transit
metastases and/or satellitosis and regional lymph nodes), one patient.
There were no cardiovascular complications and no treatment mortality.
During a follow-up of at least 4.5 years, 12 patients (55%) developed
distant metastases, including four patients with stage I disease (36%) and
eight patients with stage III disease (73%). There were no locoregional
recurrences. The median survival was three years (range, 0.5 to 12.5 years)
and the overall five-year survival was 40%, with 56% of patients having
stage I disease and 27% having stage III disease. The prognosis of
subungual melanoma is determined by the stage of the disease. Isolated
regional perfusion may prolong disease-free survival in patients with
subungual melanoma compared with previously published data.
