title: Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia.
abstract: OBJECTIVE
  To review the treatment and outcomes of malignant melanoma (MM) of the eyelid skin.
  
  
  METHODS
  Retrospective case series review.
  
  
  METHODS
  All consecutive patients who had MM arising from eyelid skin treated by 2 regional tertiary referral oculoplastic surgeons were included.
  
  
  METHODS
  Patient charts were reviewed to collect information on the main outcome measures.
  
  
  METHODS
  Demographics, clinical and histological features of the lesion, treatment, and outcomes.
  
  
  RESULTS
  Twenty-nine patients between 22 and 88 years old (mean, 65) were included. The most common site of MM occurrence was the lower eyelid. Seventeen cases arose in an area of pigmentation, 4 arose de novo, and 8 were of unknown origin. The most common histopathological types were lentigo maligna melanoma (19 cases), followed by superficial spreading MM (8 cases). Fourteen patients had in situ disease and therefore had no Breslow thickness. Another 7 patients had Breslow thickness of <0.76 mm. Thirteen patients had Clark level II or higher. According to the American Joint Committee on Cancer staging system for cutaneous melanoma, 14 patients were clinically stage 0 and 6 patients were stage IA, with thickness < or = 1 mm and no ulceration. Treatment included wide excision in all cases, one of which underwent anterior exenteration. Pathological techniques used included mapped serial excision with standard or overnight paraffin sections or Mohs' micrographic surgery. Most patients had a good outcome, although 2 died of the disease. Five patients had local recurrence, and 4 had distant metastases. Median postoperative follow-up was 3 years (range, 1 month-9 years, 9 months).
  
  
  CONCLUSIONS
  Lentigo maligna melanoma compared with other forms of MM was relatively more common in the periocular region than in other body locations. Our pathologists preferred paraffin sections to frozen section for accurate assessment of melanocytic atypia and margin status. Initial wide excision margins of 10 mm from the macroscopic edge of the tumor are suggested, as histological margins may be less than this. Margin control by mapped serial excision or a modified Mohs' micrographic surgery using paraffin sections is a useful technique to ensure complete excision and minimization of local recurrence.
authors.affiliation: Department of Ophthalmology, Royal Brisbane Hospital, Brisbane, Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Chan
authors.forename: Brett A
authors.initials: BA
authors.lastname: O'Donnell
authors.forename: Kevin
authors.initials: K
authors.lastname: Whitehead
authors.forename: William
authors.initials: W
authors.lastname: Ryman
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005142:Eyelid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015580:Mohs Surgery; D009517:New South Wales / Q000453:epidemiology; D013508:Ophthalmologic Surgical Procedures; D011793:Queensland / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome