Hyperthermic isolated limb perfusion (ILP) with melphalan is an accepted method of treatment for advanced or recurrent melanoma on a limb. In a review of 124 patients who underwent 130 ILPs at the Sydney Melanoma Unit, the anaesthetic considerations are summarized. All patients received general anaesthesia. The level of monitoring is discussed and monitoring of the limb venous pressure is important to minimize major fluid shifts between the systemic vasculature and the vascular compartment of the isolated limb and extracorporeal circuit.