Sixty patients with recurrent melanoma of an extremity were treated by major amputation. Twelve patients (21%) were free of disease an average of 13 years later. This included two patients who had forequarter amputation and two others who had hemipelvectomy. Eight of the survivors underwent hip disarticulation. There were three postoperative deaths: one from pulmonary embolism, one from splenic rupture because of metastatic melanoma, and one from sepsis. In retrospect, five of the 12 survivors might have been suitable candidates for a preliminary trial of regional perfusion with chemotherapeutic agents.
Amputation appears to be indicated when recurrent disease is extensive or when regional perfusion or other conservative measures have failed. It is encouraging that one out of five such desperately ill patients can still be salvaged by this approach.