title: Margins of excision and prognostic factors for cutaneous eyelid melanomas.
abstract: BACKGROUND
  Guidelines for wide excision of cutaneous melanomas according to Breslow thickness are impractical when considering melanomas arising on eyelid skin. No consensus exists regarding appropriate excision margins for these tumours. This study sought to determine whether excision margins influenced locoregional recurrence, and to identify prognostic factors for survival in these patients.
  
  
  METHODS
  Fifty-six cases of invasive cutaneous eyelid melanomas diagnosed between 1985 and 2011 were identified from the database of Melanoma Institute Australia. Clinical and pathological factors were assessed for their associations with recurrence and survival.
  
  
  RESULTS
  Local recurrence occurred in 12 patients (21%), nodal metastasis in 6 (11%) and distant metastasis in 2 (4%). Pathological margins>2 mm from the in situ component of the tumour were associated with increased disease-free survival (P=0.029) compared with margins≤2 mm but there was no statistically significant benefit for a pathological margin>2 mm from the invasive component. Lower eyelid melanomas were found to have a significantly higher local recurrence rate than upper eyelid melanomas (P=0.044).
  
  
  CONCLUSIONS
  This series of cutaneous eyelid melanomas is the largest yet reported. The results suggest that, as a minimum, an in vivo surgical margin of 3 mm (corresponding to a 2 mm pathological margin after tissue fixation) is desirable for eyelid melanomas. We recommend a surgical excision margin of 3 mm for eyelid melanomas≤1 mm in Breslow thickness. However, for melanomas>1 mm in thickness, the current practice of aiming to achieve 5 mm margins would seem reasonable. Patients with lower eyelid melanomas warrant particularly close follow-up given their higher local recurrence rate.
authors.affiliation: Department of Melanoma & Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Varun
authors.initials: V
authors.lastname: Harish
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Bond
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Haydu
authors.forename: Robyn P M
authors.initials: RP
authors.lastname: Saw
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Quinn
authors.forename: Ross S
authors.initials: RS
authors.lastname: Benger
authors.forename: Roger F
authors.initials: RF
authors.lastname: Uren
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stretch
authors.forename: Kerwin F
authors.initials: KF
authors.lastname: Shannon
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D054644:Ear Auricle; D005142:Eyelid Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
keywords: Eyelid neoplasms; Lymphoscintigraphy; Margins of excision; Melanoma; Prognostic factors; Sentinel lymph node biopsy