Addition of Ipilimumab (MDX-010) To Isolated Limb Infusion (ILI) With Standard Melphalan and Dactinomycin In The Treatment of Advanced Unresectable Melanoma of The Extremity

Inclusion Criteria:

- Willing and able to give written informed consent.

- Histologic diagnosis of melanoma with in transit metastasis Stage IIIB, IIIC, or IV

- Required values for initial laboratory tests:

- WBC ≥ 2000/uL

- ANC ≥ 1000/uL

- Platelets ≥ 50 x 103/uL

- Hemoglobin ≥ 8 g/dL

- Creatinine ≤ 3.0 x ULN

- AST/ALT ≤ 2.5 x ULN

- Bilirubin ≤ 3.0 x ULN, (except patients with Gilbert's Syndrome, who must have a total
bilirubin less than 3.0 mg/dL)

- No active or chronic infection with HIV, Hepatitis B, or Hepatitis C.

- Karnofsky performance status ≥60

- Men and women, ≥ 18 years of age. Women of childbearing potential (WOCBP) must be
using an adequate method of contraception to avoid pregnancy throughout the study and
for up to 8 weeks after the last dose of investigational product, in such a manner
that the risk of pregnancy is minimized. WOCBP include any female who has experienced
menarche and who has not undergone successful surgical sterilization (hysterectomy,
bilateral tubal ligation, or bilateral oophorectomy) or is not post-menopausal.
Post-menopause is defined as:

- Amenorrhea ≥ 12 consecutive months without another cause, or

- For women with irregular menstrual periods and taking hormone replacement therapy
(HRT), a documented serum follicle stimulating hormone (FSH) level ≥ 35 mIU/mL.

- Women who are using oral contraceptives, other hormonal contraceptives (vaginal
products, skin patches, or implanted or injectable products), or mechanical products
such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to
prevent pregnancy, or are practicing abstinence or where their partner is sterile (eg,
vasectomy) should be considered to be of childbearing potential. WOCBP must have a
negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent
units of HCG) within 72 hours before the start of ipilimumab.

Exclusion Criteria:

- Any other malignancy form which the patient has been disease-free for less than 2
years, with the exception of adequately treated and cured basal or squamous cell skin
cancer, superficial bladder cancer or carcinoma in situ of the cervix.

- Autoimmune disease: Patients with a history of inflammatory bowel disease are excluded
from this study, as are patients with a history of symptomatic disease (eg, rheumatoid
arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus,
autoimmune vasculitis [eg, Wegener's Granulomatosis]); motor neuropathy considered of
autoimmune origin (e.g. Guillain-Barre Syndrome).

- Any underlying medical or psychiatric condition, which in the opinion of the
investigator will make the administration of ipilimumab hazardous or obscure the
interpretation of AEs, such as a condition associated with frequent diarrhea.

- Patients with underlying heart conditions who are deemed ineligible for surgery by
cardiology consult

- Any history of prior treatment with ipilimumab or prior CD137 agonist or CTLA-4
inhibitor or agonist.

- Concomitant therapy with any of the following: IL-2, interferon, or other non-study
immunotherapy regimens; immunosuppressive agents; other investigation therapies; or
chronic use of systemic corticosteroids.

- Women of childbearing potential (WOCBP), who:

- are unwilling or unable to use an acceptable method of contraception to avoid
pregnancy for their entire study period and for at least 8 weeks after cessation of
study drug, or

- have a positive pregnancy test at baseline, or

- are pregnant or breastfeeding.

- Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for
treatment of either a psychiatric or physical (eg, infectious) illness.

- Persons of reproductive potential must agree to use an adequate method of
contraception throughout treatment and for at least 8 weeks after ipilimumab is
stopped.

- Sexually active WOCBP must use an effective method of birth control during the course
of the study, in a manner such that risk of failure is minimized. Before study
enrollment, WOCBP must be advised of the importance of avoiding pregnancy during study
participation and the potential risk factors for an unintentional pregnancy. All WOCBP
MUST have a negative pregnancy test before first receiving ipilimumab. If the
pregnancy test is positive, the patient must not receive ipilimumab and must not be
enrolled in the study.