Palliation of skeletal melanoma metastases with isolated limb perfusion chemotherapy.

Skeletal metastases are predominantly osteolytic, usually symptomatic, and carry a high risk of pathological fracture, occurring in 11% to 17% of patients with stage IV melanoma. The majority (70%–80%) involve the axial skeleton, mainly the vertebrae and ribs, whereas a minority affect the appendicular skeleton. The prognosis is poor, with a mean overall survival of 4 to 8 months, although this is increased threefold in patients with isolated appendicular metastases who are treated aggressively with surgery and/or radiotherapy. A case of multiple appendicular skeletal metastases from a primary cutaneous melanoma treated with surgical fixation followed by isolated limb perfusion (ILP) chemotherapy, resulting in significant symptomatic and radiologic improvement, is presented.