Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database

Ramachandran, Vignesh; Phan, Kevin

doi:10.1016/j.bjps.2022.08.076

Cited by 4 publications

(1 citation statement)

References 35 publications

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“…At times, a particular location might lead to a consideration of Mohs surgery rather than traditional WLE to minimize skin loss. Examples include the eyelid [ 35 ], ear [ 36 ], lips [ 37 ], face [ 38 ], hands and feet [ 39 ]. In Australia, it has been concerning that many melanoma patients’ tumors are not excised with the required margins of clearance.…”

Section: Excision Marginsmentioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

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Section: Excision Marginsmentioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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Managing cutaneous melanoma of the eyelid: Evidence from surveillance, epidemiology, and end results (SEER) program

Brenner¹

2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Head and neck melanoma: the eyelid region has a better prognosis and easier management: a retrospective survey and systematic review

Dini,

Susini,

Zuccaro

et al. 2024

Melanoma Research

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Eyelid melanoma (EM) is a malignant neoplasm accounting for around 1% of eyelid malignancies. Because of its rarity, most of our knowledge of EM is currently based on studies of cutaneous melanomas located elsewhere. Accordingly, this study aimed to specifically evaluate EM characteristics, management strategies, and prognosis. A retrospective study was carried out on patients diagnosed with EM at Careggi University Hospital, Florence between May 2012 and May 2022. In addition, a systematic review of relevant literature was conducted, encompassing studies published from 2013 to 2023. Clinical, histopathological, therapeutical, and prognostic data were analyzed to assess the metastasis rate and the 5-year survival rate of patients with EM. Separate data were extracted for in situ and invasive disease. Our original study included 19 patients diagnosed with EM with a 5-year survival rate of 100% for in situ and 83.3% for invasive EM. The literature review identified five poorly detailed large database reviews and 14 original studies on EM with an overall 5-year survival rate of 79.7%. The present research indicates that EM is a challenging malignancy, but has a relatively better prognosis and easier management than other melanomas of the head and neck region. These are probably related to the anatomical location which leads to early diagnosis. Therefore, EM should be considered as a specific disease requiring dedicated treatment. Based on the personal authors’ experience and comprehensive overview of the current knowledge, a dedicated protocol is proposed.

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Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database

Cited by 4 publications

References 35 publications

Primary Cutaneous Melanoma—Management in 2024

Primary Cutaneous Melanoma—Management in 2024

Managing cutaneous melanoma of the eyelid: Evidence from surveillance, epidemiology, and end results (SEER) program

Head and neck melanoma: the eyelid region has a better prognosis and easier management: a retrospective survey and systematic review

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