Modified Mohs micrographic surgery for periocular melanoma and melanoma in situ: long-term experience at Scripps Clinic.

BACKGROUND

Excision of invasive melanoma and melanoma in situ (MIS) using variations of the Mohs micrographic surgery (MMS) technique is becoming increasingly common in difficult areas, such as the periocular area, where standard surgical margins may not be feasible, and clinical margins are poorly defined. However, little long-term data evaluating the treatment of periocular melanoma are available in the literature.

OBJECTIVE

To present our long-term experience in the treatment of periocular melanoma using a staged, modified Mohs excision technique with rush permanent, paraffin-embedded tissue sections.

MATERIALS AND METHODS

A total of 35 patients with periocular melanoma and MIS were treated using modified MMS during a 15-year period. Twenty-nine patients were available with adequate follow-up of greater than 5 years duration. The mean follow-up duration was 94 months.

RESULTS

There were a total of five recurrences (17.2%) detected an average of 85 months after excision. Four of the five recurrent tumors had been previously excised. The recurrence rate for primary tumors was 5% (1/20). The recurrence rate for previously excised tumors was 44.4% (4/9).

CONCLUSION

Margin-control surgery is favored in the treatment of periocular melanoma to maximize the cure rate and minimize postoperative morbidity by sparing normal tissue. Ample follow-up intervals are required to adequately assess recurrence rates. The best opportunity for cure is associated with the first tumor excision.