Complete and lasting healing of bone melanoma metastasis after hyperthermic limb perfusion.

In November 2002, he presented a swelling with oedema and pain on the left distal tibia, the MRI showed a lytic bone lesion with cortical destruction. An open biopsy was positive for melanoma. After a PET-computed tomography (CT) scan excluded disease elsewhere (Fig. 1a), we performed a hyperthermic limb perfusion (HLP) with melphalan 100 mg and TNF 1 mg. In May 2003, the patient was started on high-dose IFN because of persistence of the osteolytic lesion at the standard radiographic examination. In May 2004, the contrast MRI showed a tibial fracture, which obliged the patient to walk only with the aid of crutches. With the aim of improving bone recalcification we started zoledronic acid (ZA). A new PET/CT in January 2005 showed a complete resolution of the fracture without any fluorodeoxyglucose uptake; the complete healing of the lesion was confirmed also by a contrast MRI performed in February 2005. The ZA was nevertheless continued till March 2006. The complete response persisted at the last radiograph and PET/CT scan, performed in September 2007 (Fig.1b). As of July 2008, the patient is still free from recurrence, walking normally and working full time.