Skip to main content

Advertisement

SpringerLink
Log in

Surgical margins and outcomes for eyelid melanoma: a systematic review and meta-analysis

  • ORIGINAL PAPER
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

No randomized trials exist to inform the peripheral surgical margins or depth of wide excision for eyelid melanoma. We performed a meta-analysis examining surgical margins and Breslow depth for eyelid melanomas. A systematic review was performed in August 2022 using PubMed, Cochrane, and Medline databases (1/1/1990 to 8/1/2022). Inclusion criteria included studies reporting surgical treatment of primary cutaneous melanomas of the eyelid with reported surgical margins. Ten articles were included. The studies were examined by surgical margin size (group 1: ≤ 0.5 cm; group 2 > 0.5 cm and ≤ 1.5 cm) and Breslow depth (group 1: ≤ 1 mm; group 2: > 1 mm). The odds ratio (OR) for local recurrence was 2.55 [95% CI 0.36–18.12], p = 0.18; regional metastasis was 0.70 [95% CI 0.00–23671.71], p = 0.48; and distant metastasis was 2.47 [95% CI 0.00–1687.43], p = 0.66. When examining by Breslow depth, the OR for local recurrence was 0.53 [95% CI 0.14–1.94], p = 0.34; regional metastasis was 0.14 [0.00–176.12], p = 0.54; and the OR for distant metastasis was 0.24 [95% CI 0.01–8.73], p = 0.46. There was a trend toward higher likelihood of recurrence and metastasis in the ≤ 0.5 cm group. Similarly, there is a trend toward higher likelihood of recurrence and metastasis with Breslow depth > 1 mm. A surgical margin of at least 0.5 cm and achievement of negative margins via permanent sections or MMS are likely needed to prevent adverse outcomes. En face sectioning may be a superior method of histological processing for eyelid melanoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

References

  1. Boulos PR, Rubin PA (2006) Cutaneous melanomas of the eyelid. Semin Ophthalmol 21(3):195–206

    Article  PubMed  Google Scholar 

  2. Rodriguez-Sains JF (1998) Eyelid and conjunctival neoplasms. CV Mosby, St Louis

    Google Scholar 

  3. Pathak S, Zito PM (2023) Clinical guidelines for the staging, diagnosis, and management of cutaneous malignant melanoma, StatPearls, StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC., Treasure Island (FL) ineligible companies

  4. Bladen JC, Malhotra R, Litwin A (2023) Long-term outcomes of margin-controlled excision for eyelid melanoma. Eye (London) 37(5):1009–1013

    Article  Google Scholar 

  5. Alghoul M, Pacella SJ, McClellan WT, Codner MA (2013) Eyelid reconstruction. Plast Reconstr Surg 132(2):288e–302e

    Article  CAS  PubMed  Google Scholar 

  6. Chang EI, Esmaeli B, Butler CE (2017) Eyelid Reconstruction. Plast Reconstr Surg 140(5):724e–735e

    Article  CAS  PubMed  Google Scholar 

  7. Shumaker PR, Kelley B, Swann MH, Greenway HT Jr (2009) Modified Mohs micrographic surgery for periocular melanoma and melanoma in situ: long-term experience at Scripps Clinic. Dermatol Surg 35(8):1263–1270

    Article  CAS  PubMed  Google Scholar 

  8. Harish V, Bond JS, Scolyer RA, Haydu LE, Saw RP, Quinn MJ, Benger RS, Uren RF, Stretch JR, Shannon KF, Thompson JF (2013) Margins of excision and prognostic factors for cutaneous eyelid melanomas. J Plast Reconstr Aesthet Surg 66(8):1066–1073

    Article  PubMed  Google Scholar 

  9. Esmaeli B, Youssef A, Naderi A, Ahmadi MA, Meyer DR, McNab A (2003) Margins of excision for cutaneous melanoma of the eyelid skin: the Collaborative Eyelid Skin Melanoma Group Report. Ophthalmic Plast Reconstr Surg 19(2):96–101

    Article  PubMed  Google Scholar 

  10. Veronesi U, Cascinelli N, Adamus J, Balch C, Bandiera D, Barchuk A, Bufalino R, Craig P, De Marsillac J, Durand JC et al (1988) Thin stage I primary cutaneous malignant melanoma. Comparison of excision with margins of 1 or 3 cm. N Engl J Med 318(18):1159–1162

    Article  CAS  PubMed  Google Scholar 

  11. National Comprehensive Cancer Network. Melanoma: Cutaneous (Version 3.2022). https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf

  12. Vaziri M, Buffam FV, Martinka M, Oryschak A, Dhaliwal H, White VA (2002) Clinicopathologic features and behavior of cutaneous eyelid melanoma1 1No reprints will be available. Ophthalmology 109(5):901–908

    Article  PubMed  Google Scholar 

  13. Malhotra R, Chen C, Huilgol SC, Hill DC, Selva D (2003) Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma. Ophthalmology 110(10):2011–2018

    Article  PubMed  Google Scholar 

  14. Chan FM, O’Donnell BA, Whitehead K, Ryman W, Sullivan TJ (2007) Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia. Ophthalmology 114(1):187–192

    Article  PubMed  Google Scholar 

  15. Demirci H, Johnson TM, Frueh BR, Musch DC, Fullen DR, Nelson CC (2008) Management of periocular cutaneous melanoma with a staged excision technique and permanent sections: the square procedure. Ophthalmology 115(12):2295-2300.e3

    Article  PubMed  Google Scholar 

  16. Then SY, Malhotra R, Barlow R, Kurwa H, Huilgol S, Joshi N, Olver J, Collin R, Selva D (2009) Early cure rates with narrow-margin slow-Mohs surgery for periocular malignant melanoma. Dermatol Surg 35(1):17–23

    CAS  PubMed  Google Scholar 

  17. Moyer JS, Rudy S, Boonstra PS, Kraft C, Chinn SB, Baker SR, Schwartz JL, Bichakjian CK, Fullen D, Durham AB, Lowe L, Johnson TM (2017) Efficacy of staged excision with permanent section margin control for cutaneous head and neck melanoma. JAMA Dermatol 153(3):282–288

    Article  PubMed  Google Scholar 

  18. Felton S, Taylor RS, Srivastava D (2016) Excision margins for melanoma in situ on the head and neck. Dermatol Surg 42(3):327–334

    Article  CAS  PubMed  Google Scholar 

  19. Jones EL, Jones TS, Pearlman NW, Gao D, Stovall R, Gajdos C, Kounalakis N, Gonzalez R, Lewis KD, Robinson WA, McCarter MD (2013) Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result. JAMA Surg 148(5):456–461

    Article  PubMed  Google Scholar 

  20. Yin VT, Warneke CL, Merritt HA, Esmaeli B (2014) Number of excisions required to obtain clear surgical margins and prognostic value of AJCC T category for patients with eyelid melanoma. Br J Ophthalmol 98(12):1681–1685

    Article  PubMed  Google Scholar 

  21. Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Hoeller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P (2022) European consensus-based interdisciplinary guideline for melanoma. Part 2: treatment—update 2022. Eur J Cancer 170:256–284

    Article  PubMed  Google Scholar 

  22. Connolly KL, Nijhawan RI, Dusza SW, Busam KJ, Nehal KS (2016) Time to local recurrence of lentigo maligna: implications for future studies. J Am Acad Dermatol 74(6):1247–1248

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Dermatology, Brigham and Woman’s Hospital, Boston, USA

    Catherine E. Pisano

  2. Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 12th Floor, New York, NY, 10032, USA

    Megan H. Trager & Faramarz H. Samie

  3. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA

    Weijia Fan

Authors
  1. Catherine E. Pisano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Megan H. Trager
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weijia Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faramarz H. Samie
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CP and MT wrote the manuscript text. CP and FS study design and data review. WF data analysis. CP, MT, FS prepared tables and figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Megan H. Trager.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflict of interest

None of the authors have competing interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pisano, C.E., Trager, M.H., Fan, W. et al. Surgical margins and outcomes for eyelid melanoma: a systematic review and meta-analysis. Arch Dermatol Res 316, 106 (2024). https://doi.org/10.1007/s00403-024-02834-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00403-024-02834-3

Keywords

Search

Navigation