Isolated Limb Perfusion in Melanoma Treatment
Summary
Isolated limb perfusion (ILP) is a regional chemotherapy technique designed to deliver high doses of cytotoxic agents directly to an affected limb while limiting systemic exposure. Originally developed in the 1950s, ILP involves surgical cannulation of the major artery and vein supplying the limb, followed by extracorporeal circulation of a heated perfusate containing melphalan, often combined with mild hyperthermia. The procedure can achieve tumour response rates exceeding 70 per cent in patients with in-transit metastases confined to an extremity, offering limb salvage in otherwise unresectable cases. Hyperthermia enhances drug uptake and tumour cell kill, while limb isolation reduces systemic toxicity. Beyond direct cytotoxicity, ILP induces immunogenic cell death, releasing tumour antigens and heat-shock proteins that may prime systemic anti-tumour immunity. Modern practice integrates ILP with evolving systemic therapies—immune checkpoint inhibitors and targeted agents—to address microscopic disease and reduce recurrence. Patient selection, technical expertise and perioperative management are critical to minimise complications such as regional toxicity, compartment syndrome and systemic leakage. Globally, ILP remains a valuable option in multidisciplinary melanoma care, particularly where novel systemic agents are inaccessible or in cases of locoregional progression despite immunotherapy.
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Isolated Limb Perfusion in Melanoma Treatment publication trend
The graph below shows the total number of articles in isolated limb perfusion in melanoma treatment across all publications each year (not limited to Nature Index journals).
Technical terms
Isolated limb perfusion (ILP): A surgical technique that delivers high-dose chemotherapy to a limb via extracorporeal circulation while excluding systemic circulation.
Melphalan: An alkylating chemotherapeutic agent commonly used in ILP to induce tumour cell death.
In-transit metastasis: Tumour deposits occurring in lymphatic channels between the primary melanoma site and regional lymph nodes.
Hyperthermia: Elevation of perfusate temperature (usually to 39–41 °C) during ILP to enhance chemotherapy efficacy and tumour susceptibility.
References
- Isolated Limb Perfusion With Melphalan Triggers Immune Activation in Melanoma Patients. Frontiers in Oncology (2018).
- Locoregional management of in-transit metastasis in melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline.. Current Oncology (2020).
- The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options. Cancers (2015).
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