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John C Bladen, Fiona Lawson, Andre Litwin, Raman Malhotra; Long-term outcome measures for eyelid melanoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3635.
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© ARVO (1962-2015); The Authors (2016-present)
Melanoma is one of the deadliest forms of skin cancer and ranked 5th most common cancer worldwide. Melanoma of the head and neck have the highest mortality, however eyelid prognosis is unknown. In the UK, surgery is the mainstay of treatment with excision margin recommendations of 0.5cm for melanoma in-situ (MiS), 1cm for lesions <1mm depth, 1-2cm for lesion 1-2mm thick and 2-3cm for thicker lesions. Nonetheless, such margins are large in the periocular region. Aim: To assess if current practice is leading to the best long-term outcome measures for patients with eyelid melanoma.
Retrospective case review of primary eyelid melanoma presenting to a single centre melanoma unit (Queen Victoria Hospital) over 10 years. 22 patients were identified: 7 females/15 males; 13 left and 10 right eye; 21 lower and 2 upper eyelids. Specific management standards were assessed including excision margin used, immediate re-excision rate, recurrence rate, imaging for nodal/stage IIC, genetic analysis in high risk/recurrent cases, use of sentinel node biopsy, advanced melanoma therapies and vitamin D levels.
Overall survival of 91% (2 deaths from nodular and lentigo maligna melanoma). Histological diagnosis: 7 MiS, invasive melanoma: 8 lentigo maligna, 4 nodular, 2 amelanotic & 1 desmoplastic. Mean for invasive disease: Breslow of 6mm (range 0.5-26), Clark 4 (range 3-5) mitotic rate 8 (1-30) and 2 ulcerations, 2 perineural/lymphovascular invasions, 4 brisk infiltrating lymphocytes, 4 regression, 7 genetic testing with 2 tumours containing actionable genes (BRAF/NRAS). Mean excision margins used for MiS 3mm (range 2-5mm) and invasive 5mm (range 2-10). Immediate re-excisions were performed in 9 (41%; 2 went on to recur) and 6 recurred. Imaging occurred for node/advanced disease. Sentinel node biopsy was not performed. Advanced melanoma therapy 2 cases. No vitamin D testing occurred.
Survival rates are in line with 90% overall survival in the UK, however, this includes 7 cases of MiS. Recommended Vitamin D evidence needs to be put into clinical practice. Excision margins vary with high re-excision rate of 41%, which needs to be conveyed to patients undergoing treatment. In addition, upstaging of MiS occurred, advocating excision rather than observation. Further studies are needed to determine the optimal management of eyelid melanoma.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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