Granulomatous lymphangitis. A complication of intralymphatic immunotherapy with methanol extraction residue of BCG (MER).

Patients with thick primary melanomas, (Stage I) or regional nodal spread (Stage II) are at substantial risk for recurrence following usual definitive surgical excision of the primary tumor with or without lymphadenectomy. Trials of nonspecific adjuvant agents such as bacille Calmette Guerin (BCG) in experimental animals and man suggest that antitumor effects are greatest when the agent is injected near tumor of limited mass. We report a new approach to adjuvant therapy using preoperative intralymphatic injections and intraoperative local instillations of the nonviable methanol extraction residue of bacille Calmette Guerin (MER). Thirteen individuals with thick primaries, regional metastases, or recurrent melanoma of the extremities have entered the experimental program. We report here one complication of this immunotherapy observed in four of 13 treated individuals, granulomatous lymphangitis. The clinical presentation, course, and treatment of this complication are described. Its potential relation to the success of this therapy is discussed.