Giant melanoma of the left thumb

A 74-year-old female patient is described with a giant melanoma of the left thenar and concomitant bilateral pulmonary metastases. Palliative treatment consisted of a two-staged procedure in order to save the limb from amputation. Firstly, perfusion with gamma-interferon, tumour necrosis factor- α and melphalan was carried out, after which the tumour had been reduced to one third of its initial volume. Secondly, excision of the tumour and coverage of the wound with a split skin graft was done. Remarkably, the extent of the multiple pulmonary metastases was temporary and diminished 1 month after perfusion, although no systemic leakage could be determined during the procedure. The management strategy is discussed with emphasis on this indication for limb perfusion.