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The treatment of melanoma in transit metastases can vary widely and is dependent on the size and number of lesions. When many, large lesions exist, isolated limb perfusion (ILP) can be used as an attractive treatment option with high response rates. We review here the various methods of treatment for melanoma in transit metastases, with a focus on ILP. Indications and results are discussed, and the extra value of tumour necrosis factor (TNF) is evaluated. ILP with melphalan results in complete response rates of 40 to 82% (54% in a large retrospective metaanalysis). The addition of TNF can improve these complete response rates (59-85%), and although no data from randomized controlled trials are available, TNF seems of particular value in large, bulky lesions or in patients with recurrent disease after previous ILP. TNF-based ILP has earned a permanent place in the treatment of patients with melanoma it transit metastases. In patients with a high tumor burden, TNF-based ILP is the most efficacious procedure to obtain local control and achieve limb salvage. [ABSTRACT FROM AUTHOR]