title: Management of periocular cutaneous melanoma with a staged excision technique and permanent sections the square procedure.
abstract: OBJECTIVE
  To evaluate the outcome of the square procedure, a multidisciplinary, staged excision technique using standard formalin-fixed, vertically oriented sections for periocular cutaneous melanoma.
  
  
  METHODS
  Observational, retrospective, case series.
  
  
  METHODS
  Forty patients with periocular cutaneous melanoma treated with the square procedure.
  
  
  METHODS
  Demographic features, tumor data, and recurrence rate were reviewed retrospectively for 40 patients with periocular cutaneous melanoma treated with the square procedure.
  
  
  METHODS
  Local recurrence rate.
  
  
  RESULTS
  Of 40 patients, 26 (65%) had lentigo maligna melanoma in situ (MIS), 12 (30%) had lentigo maligna melanoma, and 2 (5%) had superficial spreading melanoma. Tumor-free margins were reached within a mean margin of 13 mm for patients with MIS and of 16 mm for patients with invasive melanoma. There was no statistical difference for the margin width in patients with MIS and invasive melanoma. The lesion size and margin width were significantly correlated. Recurrence was observed in 1 (2.5%) patient at 8 months after the square procedure, and a Kaplan-Meier survival curve estimated a local recurrence rate of 2.5% at 8 years.
  
  
  CONCLUSIONS
  The square procedure is an effective procedure for management of periocular lentigo maligna melanoma in situ and lentigo maligna melanoma with a low local recurrence rate of 2.5% at 8 years.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
authors.forename: Bartley R
authors.initials: BR
authors.lastname: Frueh
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Fullen
authors.forename: Christine C
authors.initials: CC
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005138:Eyebrows / Q000473:pathology*; D005142:Eyelid Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps