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Cancers 2015, 7(3), 1154-1177; doi:10.3390/cancers7030830

The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options

1
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
2
Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Chyi-Chia Richard Lee
Received: 16 May 2015 / Revised: 17 June 2015 / Accepted: 24 June 2015 / Published: 1 July 2015
(This article belongs to the Special Issue Current Topics in Cutaneous Melanoma)
View Full-Text   |   Download PDF [202 KB, uploaded 1 July 2015]

Abstract

The incidence of melanoma has been increasing at a rapid rate, with 4%–11% of all melanoma recurrences presenting as in-transit disease. Treatments for in-transit melanoma of the extremity are varied and include surgical excision, lesional injection, regional techniques and systemic therapies. Excision to clear margins is preferred; however, in cases of widespread disease, this may not be practical. Historically, intralesional therapies were generally not curative and were often used for palliation or as adjuncts to other therapies, but recent advances in oncolytic viruses may change this paradigm. Radiation as a regional therapy can be quite locally toxic and is typically relegated to disease control and symptom relief in patients with limited treatment options. Regional therapies such as isolated limb perfusion and isolated limb infusion are older therapies, but offer the ability to treat bulky disease for curative intent with a high response rate. These techniques have their associated toxicities and can be technically challenging. Historically, systemic therapy with chemotherapies and biochemotherapies were relatively ineffective and highly toxic. With the advent of novel immunotherapeutic and targeted small molecule agents for the treatment of metastatic melanoma, the armamentarium against in-transit disease has expanded. Given the multitude of options, many different combinations and sequences of therapies can be offered to patients with in-transit extremity melanoma in the contemporary era. Reported response and survival rates of the varied treatments may offer valuable information regarding treatment decisions for patients with in-transit melanoma and provide rationale for these decisions. View Full-Text
Keywords: in-transit melanoma; regional cancer therapy; immunotherapy in-transit melanoma; regional cancer therapy; immunotherapy
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Gabriel, E.; Skitzki, J. The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options. Cancers 2015, 7, 1154-1177.

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